Association for Behavior Analysis International

Individuals with intellectual and developmental disabilities (I/DD) who also present with medical or psychiatric co-morbidities can experience greater behavioral challenges and poorer quality of life. Medical issues are often underdiagnosed in those with I/DD due to factors such as communication limitations and difficulties complying with medical procedures. Even when medical care is obtained, health care systems are often not equipped to serve people with I/DD. These factors result in disparities in healthcare for individuals with I/DD. In this symposium, we will describe the relationship between medical and psychiatric conditions and challenging behaviors such as aggression and self-injury. We will provide the audience with ways to identify possible medical and psychiatric conditions in those with limited communication. Finally, we will present health care system challenges in serving this population and ways in which behavior analysts can engage in advocacy efforts to ensure better care for those with complex needs.

Those who have completed the BACB coursework series.

The Professional and Ethical Compliance Code for Behavior Analysts outlines that behavior analysts should refer a client for medical consultation if there is a possibility that a behavior being targeted for intervention may be due to a medical or biological condition. As such, behavior analysts should be aware of behavioral indicators of medical conditions in order to ensure proper referrals are made as part of a treatment plan. In this presentation, I will describe research supporting the relationship between medical problems and challenging behaviors and identify barriers to obtaining adequate healthcare in those with Intellectual and Developmental Disabilities. I will present case study data from our residential care setting and share behavioral indicators and assessments used to identify possible medical conditions in those with limited language. Finally, I will describe preventative measures behavior analysts can apply to ensure better overall health for their clients.

Abstract: Individuals diagnosed with autism or other related neurodevelopmental disorders are commonly also diagnosed with other comorbid diagnoses including medical and psychiatric conditions. Related to psychiatric diagnosis, many times individuals are diagnosed with serious mental health diagnoses including: bipolar disorder, schizophrenia, schizoaffective disorder, impulse control disorder, as well as others. Many times these diagnoses are given due to the externalizing behavioral challenges accompanied with the individuals presentation and the medication that is given to treat and decrease these behavioral challenges, namely antipsychotics to decrease the individuals target behaviors. However, with the work we are doing at NYC Health and Hospitals/Kings County adult inpatient unit for individuals with autism/IDD and comorbid mental health diagnoses we have found that there is an overestimation of more chronic, serious mental health disorders and instead these individuals have other missed psychiatric diagnoses including: anxiety disorders, depression, and PTSD (due to missed identified trauma). In this talk, proper identification and assessment of psychiatric comorbidities will be discussed. The impact of trauma on externalizing behavioral disorders will also be discussed and strategies how to assess and identify trauma in individuals with varying types of autism (mild to severe). Lastly, we will discuss the importance of collaboration with mental health professionals to ensure proper assessment, treatment, and integration into behavioral programming for the individual.

Approximately 4.5 million people in the United States have a developmental disability. Persons with developmental disabilities not only require the same access to quality healthcare as anyone else, but are at increased risk of some medical or psychiatric conditions related to their disabilities. Individuals with Intellectual and Developmental Disabilities (I/DD) report inequities in healthcare such a less satisfaction with their health, shorter life expectancy than the general population, less access to preventative care, higher rates of diagnoses such as obesity, disabilities, arthritis, and asthma, poorly managed chronic health conditions, over utilization of psychotropic medications, and higher rates of mortality (State of Nebraska, 2020). Importantly, if individuals with disabilities need behavior supports, they have higher rates of these disparities than the rest of the disability population. Due to these challenges, individuals with I/DD are 9 times more likely to experience an inpatient hospitalization due to medical or behavioral challenges than their peers. Once in the hospital, gaps in understanding of the impact of I/DD on medical, behavioral or mental health needs, often results in diagnostic overshadowing, overmedication, increased length of stay, and at worst, crisis events. More often than not individuals with I/DD or their caregivers report high levels of dissatisfaction with emergency or inpatient care. Behavior analysts are uniquely trained impact the healthcare system through system analysis, implementing of workflows, execution of training, and analysis of both staff and patient behavior. In addition, the unique skill set a behavior analyst has to understand, intervene on, and support improvements in complex behavioral events is not only essential but highly valued in the healthcare environment. I will share contemporary data that supports healthcare inequity for those with IDD, and case study data that demonstrate the impact behavior analysts can have on patients with complex behavioral and medical conditions.