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InPsych 2017 | Vol 39

April | Issue 2

Cover feature : Developmental disorders in adulthood

Developmental disorders in adulthood

Developmental disorders (also known as neurodevelopmental disorders) are a group of conditions with onset during childhood – generally present to some degree from birth. These disorders are characterised by developmental deficits that produce impairments of personal, social, academic or occupational functioning. The range of these developmental deficits varies from relatively mild limitations of executive functioning to global impairments of social skills or intelligence. The developmental disorders frequently co-occur with mental health conditions which can make the impact of the disorders more complex (American Psychiatric Association [APA], 2013).

This issue of InPsych will look at a number of developmental disorders with a focus on the presentation of developmental disorders in adulthood. It is important to keep in mind that there is substantial heterogeneity across many developmental disorders. Thus, this heterogeneity often makes it difficult to predict actual outcomes in adulthood (Lee, Sibley, & Epstein, 2016). A unifying theme of this edition of InPsych will explore the possible, and sometimes probable, outcomes in adulthood, the challenges faced by people with neurodevelopmental disorders, and the role of psychologists in engaging and working with this population group to improve outcomes. As we better understand the adult developmental context of these disorders, this should help us tailor interventions to improve long-term goals.

Key issues for people with developmental disorders

People with developmental disorders, and people with disability generally, experience discrimination and disadvantage. Australian data show that people with disabilities have a lower quality of life. They are more likely to experience poverty, insecure housing and social isolation. When compared to people without a disability they have a higher incidence of comorbidities including mental health problems and a range of physical conditions, are less likely to live independently, be in employment and to have a social network (Australian Human Rights Commission, 2014). People with developmental disorders are also over-represented in the criminal justice system, and/or under-diagnosed within the prison population.

The United Nation’s Convention on the Rights of Persons with Disabilities (The United Nations, 2006), of which Australia is a signatory, has been instrumental in changing approaches and attitudes in the way persons with disabilities are understood and supported. It asserts that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms. It reinforces that all categories of rights apply to persons with disabilities and identifies areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and where protection of rights must be upheld. This includes areas of health care, incorporating psychological practice. Many of the principles of the Convention are reflected in Australia’s National Disability Insurance Scheme which aims to provide people with developmental disorders with greater choice and control to achieve their goals and aspirations, participate in and contribute to society, and to have a say in their own future.

While the articles in the cover feature focus on the impact of developmental disorders on adulthood, it is important to reflect on how the disorder may have impacted on the earlier psychosocial milestones as well as the key transition points in life as the individual moves from child to adolescent and into adulthood. Key transition points such as the move from school to employment, from the family home to independent living, and the exploration of intimate relationships, can all be welcome but also unsettling periods for individuals with developmental disorders and their families. Psychologists have much to offer that can assist the individual at these times, as well as the other key people in their life. The effectiveness of psychological interventions for use with people with developmental disorders has largely focused on interventions for children and their families with little research investigating effectiveness for adults with developmental disorders. Another of the cover feature articles looks at the evidence for the use of focused psychological interventions for people with intellectual disability and provides strategies and guidance for psychologists working with this population group.

Featured disorders

Autism spectrum disorder (ASD)
ASD is a developmental disorder characterised by impairments in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behaviour, interests or activities. ASD is four times more likely to be diagnosed in males than in females, but females are more likely to exhibit accompanying intellectual disability (APA, 2013).
Adulthood has its own set of challenges for persons with ASD. These individuals may have difficulty becoming independent because of their rigidity in coping and difficulty with new situations. Adults with ASD are reported to have lower levels of social relationships. These individuals are likely to have difficulty obtaining employment, and if employed, are often over-educated for their jobs (Poon & Sidhu, 2017). The article on page 16 provides an overview of the outcomes for adults with ASD.
Attention deficit/hyperactivity disorder (ADHD)
ADHD is a developmental disorder that has the essential feature of a persistent pattern of inattention and/or hyperactivity-impulsiveness which interferes with functioning or development (APA, 2013). Adults with ADHD achieve lower levels of education and are less likely to reach the financial status of their parents and non-ADHD peers. However, the few studies that have investigated outcomes in adulthood indicate that those who did become employed are no different from their non-ADHD peers in terms of job status and employer satisfaction with their work performance (Lee, Sibley, & Epstein, 2016).
Due to the executive functioning weaknesses associated with ADHD, explicitly impulse control and deficits in rule-governed behaviour, persons with ADHD (specifically those with untreated or under-treated ADHD) have an increased risk of legal charges and incarceration. Various studies looking at the incident of ADHD in prison populations have estimated the rates to be between 26 and 40 per cent (Young, Moss, Sedgwick, Fridman, & Hodgkins, 2015). It is concerning that a very treatable condition can lead to such serious ramifications if not adequately managed. The article on page 18 looks at the multidisciplinary management of adults with ADHD.
Intellectual developmental disorder (IDD)
IDD pertains to deficits in general mental abilities and impairment in everyday adaptive functioning (APA, 2013). The intellectual functions involved are reasoning, problem-solving, planning, abstract thinking, judgement and learning from experience. Problems in adaptive functioning pertain to how well a person can achieve personal independence and social responsibility as would be expected for someone of their age, gender and sociocultural background. Adults with IDD are vulnerable in social situations, both with non-IDD individuals as well as other IDD individuals (Hartley & MacLean, 2009). For adults with IDD, problems in social situations occur more frequently and are more stressful than other types of negative events and it is reported that the most difficult interpersonal skill to control for persons with IDD is aggression.
In countries such as Australia, adults with IDD who live into their forties are very likely to survive into old age. Often, however, their main source of support – parents and siblings – are no longer living or are dealing with their own ageing issues.
Fetal alcohol syndrome disorder (FASD)
FASD relates to the range of physical, behavioural, cognitive and neurodevelopmental deficits that result from the fetus's exposure to alcohol. The range and severity of FASD symptoms differs from one person to another but the symptoms remain apparent throughout the person’s life. The prevalence of FASD has been difficult to define due to the complexity in diagnosing FASD and varies considerably.
As adults, those with FASD often demonstrate uncontrolled repetition of a particular response – ideas or activities may appear compulsive and/or rigid, they have poor social skills and difficulty holding jobs, have problems with living independently and safely parenting children, problems managing their finances, difficulty in relationships, and alcohol and other substance misuse1. The article on page 14 looks at FASD in the Indigenous population where higher rates of the disorder have been found.

Conclusion

As we psychologists are better able to identify and diagnose adults with developmental disorders, we need to also focus on increasing research into interventions that can assist the person in coping with the development of self-growth that all adults will experience over their lifetime. The field of psychology needs to move beyond identification of risk factors and protective processes and look at underlying competence and impairment (Rutter, 2006). We also need to remember that developmental disorders can co-occur with mental health problems and this also needs to be considered in our research and interventions.

The articles in this InPsych edition will provide a broad view of the role of psychologists in working with adults with developmental disorders and will provide a practical focus on intervention which will be another resource for psychologists who are currently working with this population or will work with these individuals in the future. It is hoped that these articles will inspire readers to seek further education and training to work with these unique adults and to also encourage readers to extend their practice to working with these individuals.

The author can be contacted at dwilmoth@bond.edu.au

APS references

The following APS resources can assist members to better understand the implications on psychological practice of working with someone with a developmental disorder and provide guidance on how to work more effectively with this client group.

Ethical guidelines for psychological practice with clients with an intellectual disability

Practice guide for psychological testing with people with disability

The APS Psychology of Intellectual Disability and Autism Interest Group provides resources and professional development activities to support members working with this client group

References

  • APA (American Psychiatric Association). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
  • Australian Human Rights Commission. (2014). Face the facts: Disability rights. Retrieved from www.humanrights.gov.au/sites/default/files/FTFDisability.pdf
  • Hartley, S. L., & Maclean, W. E. (2009). Stressful social interactions experienced by adults with mild intellectual disability. Am J Intellect Dev Disabil, 114(2), 71-84.
  • Lee, S. S., Sibley, M. H., & Epstein, J. N. (2016). Attention-deficit/hyperactivity disorder across development: Predictors, resilience, and future directions. J Abnorm Psychol, 125(2), 151-153.
  • Poon, K. K., & Sidhu, D. J. (2017). Adults with autism spectrum disorders: a review of outcomes, social attainment, and interventions. Curr Opin Psychiatry, 30(2), 77-84.
  • Rutter, M. (2006). Genes and behaviour: Nature-nurture interplay explained. New York, NY: Wiley.
  • The United Nations. (2006). Convention on the rights of persons with disabilities. Treaty Series, 2515, 3.
  • Young, S., Moss, D., Sedgwick, O., Fridman, M., & Hodgkins, P. (2015). A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med, 45(2), 247-258.

Disclaimer: Published in InPsych on April 2017. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.