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

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

edited by Roxanne C. Dryden-Edwards, MD, and Lee Combrinck-Graham, MD. The Johns Hopkins University Press, Baltimore, MD, 2010, 376 pages, $67.00 (hardcover).

As a provider who works with individuals with developmental disabilities, I am always on the lookout for good resources that can assist me in offering better patient care. This book provides an overview and then covers specific developmental disabilities, etiology and assessment, community living, interventions, and special issues. Overall, I found this book to be a worthwhile addition to the library of any psychiatrist who evaluates and treats this population.

The first section describes and defines developmental disabilities across the life span. Once I progressed through the abundance of statistics in the first chapter, the rest of the section was informative and easy to read. It compares and contrasts a typically developing person and a person with a developmental disability using Erikson’s developmental stages. This book focuses on the importance of the family in raising the person with a developmental disability and emphasizes the importance of the family’s support system and network of providers. The dialogue in this book matches my clinical experience in that families who have and are able to utilize outside support fare much better than isolated families. People with developmental disabilities are living longer. The chapter "Geropsychiatric Aspects" reviews the impact of aging with some information on using medications in elderly patients for mood disorders, sleep, and dementia. The next chapter provides an overview of the autism spectrum disorders with information on etiologic theories and definitions of the various disorders within the autism spectrum, the typical diagnostic process, commonly occurring symptoms, and various types of interventions. The chapter reminds us that individuals with an autism spectrum disorder can lead fulfilling and productive lives.

The next section reviews the etiology and assessment of developmental disabilities. The first chapter provides a brief but useful overview of the most common causes of intellectual disability, including Angelman syndrome, Down syndrome, Williams syndrome, and fragile X syndrome. Unfortunately, the chapter lacks pictures; since many of these syndromes have specific dysmorphic features, a very useful addition would have been photographs. The subsequent chapter provides an excellent brief overview on environmental exposure and intellectual disability. The topics include fetal alcohol syndrome, intrauterine drug exposure, congenital infections, and environmental toxicants. The chapter on traumatic brain injury describes the syndrome in children, the major causes, and the effects on brain development and possible interventions; there is a comparison of typical brain development with development after a brain injury. The final chapter in this section explains the different assessment approaches for autism, intelligence, sensory issues, and mood symptoms with some excellent recommendations of other issues to consider such as hearing and vision, medical conditions, and psychiatric disorders.

The community living section promotes the integration of people with developmental disabilities into community environments. It discusses the different resources that must be implemented. The systems management chapter provides a system of care model for people with developmental disabilities. I appreciated how its definition accounted not only for basic needs but also for employment and leisure activities. Case examples illustrated the importance of effective communication and how these concepts could be utilized in real life.

The next section focuses on interventions to improve the lives of people with developmental disabilities. The first chapter provides a good overview of the education system, with explanations of federal laws, common terms, the typical assessment process, individualized educational plans, behavioral supports, and school obligations. Nobody who works with youth with developmental disabilities can practice without this knowledge. The next part provides an excellent overview of the use of psychopharmacology to treat symptoms and behaviors associated with developmental syndromes. Not all symptoms or difficulties can be treated by medications, and behavioral treatment plays a key role. This chapter provides an excellent overview of the assessment and intervention process for dealing with problem behaviors in people with developmental disabilities. It includes discussions on topics such as functional behavioral assessments, descriptive assessments, behavior intervention plans, consequence-based interventions, proactive interventions, and how one monitors the behaviors and the plan that was implemented.

The final section focuses on legal, ethical, and advocacy issues. It emphasizes the importance of respect for the clients and of maximizing their quality of life and describes the laws that protect people with developmental disabilities. It touches briefly on assessing the capacity of the person with a developmental disability to make decisions and the psychiatrist’s role in this process. As many people with developmental disabilities are unable to advocate for themselves, it is critical that they have others who can advocate for them. Reverting back to the life cycle concept that was shared initially, this chapter describes how advocacy changes over the life span. It emphasizes who needs to advocate for this population and what steps they need to take.

When I began my work with people with developmental disabilities, I discovered that many of the issues that I encountered in my daily practice had not been covered during my education. This book would have been very helpful. It provides an excellent overview of the medical and psychiatric issues of this population in addition to information on development, critical role of the family and other supportive individuals, systems of care interventions and services, and advocacy. This book is an essential resource to new practitioners but is also useful for experienced psychiatrists.

Felissa Goldstein, MD

felissa.goldstein@choa.org

Author affiliations: Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia.

Potential conflicts of interest: None reported.

doi:10.4088/JCP.11bk07591

© Copyright 2012 Physicians Postgraduate Press, Inc.