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Advances in Mental Health and Intellectual Disabilities
Comorbid mental health disorders in children and young people with intellectual disabilities and autism
spectrum disorders
Ereny Gobrial,
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Ereny Gobrial, (2019) "Comorbid mental health disorders in children and young people with intellectual disabilities
and autism spectrum disorders", Advances in Mental Health and Intellectual Disabilities, https://doi.org/10.1108/
AMHID-05-2018-0026
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Comorbid mental health disorders in
children and young people with
intellectual disabilities and autism
spectrum disorders
Ereny Gobrial
Abstract
Purpose –Children and young people with comorbid intellectual disabilities (ID) and autism spectrum
disorders (ASD) are more likely to exhibit comorbid mental health disorders (MHD) and other significant
behaviours (SB) in addition to the core symptoms of ASD. The purpose of this paper is to identify the
prevalence of comorbid MHD and behaviours in children and young people with ID and ASD in Egypt.
Design/methodology/approach –The Reiss scale for children’s dual diagnosis was administered by
parents and teachers of 222 Egyptian children and young people with mild/moderate ID and ASD to
screen for MHD and SB. The mean age of children and young people was 12.3 years (SD ¼3.64), with
75.6 per cent male.
Findings –The results revealed that 62.2 per cent of children and young people with ID and ASD had high
rates of comorbid MHD and behaviour disorders were shown in 64.4 per cent of the participated children and
young people. The results identified anger, anxiety and psychosis being the most frequently diagnosed
disorders while crying spells and pica were the most SB. No differences were found between the male
and female with ID and ASD in the current study.
Research limitations/implications –Mental health assessment of children and young people with ID and
ASD will help to highlight the needs of these vulnerable children and develop the appropriate services.
Originality/value –The findings highlight the prevalence of MHD in children and young people with ID and
ASD in Egypt. This has implications on the assessment of comorbid disorders and services needed for
children with ID and ASD in Egypt.
Keywords Egypt, Mental health, Children, Intellectual disabilities, Comorbidity, Autism spectrum disorder
Paper type Research paper
Introduction
There is substantial evidence emphasising that children and young people with intellectual
disabilities (ID) are more vulnerable to experience comorbid mental health disorders (MHD) than
typically developed children (Emerson and Hatton, 2007; Einfeid et al., 2011; Munir, 2016).
A prevalence of 36 per cent comorbid MHD including problem behaviours has been
reported in children and young people with ID, compared with 8 per cent in those without ID
(Hughes-McCormack et al., 2017). Similarly, children with autism spectrum disorder (ASD) are at
a significantly higher risk of comorbid psychopathology (De Bruin et al., 2007; Matson and
Nebel-Schwalm, 2007; Parr et al., 2011; Salazar et al., 2015; Lever and Geurts, 2016). Mattila
et al. (2010) reported 74 per cent multiple comorbid psychiatric disorders in children with ASD,
suggesting that behavioural disorders were shown in 44 per cent.
Although research evidence has indicated that children and young people with comorbid ID and
ASD are more prone to experience MHD compared to individuals without ASD, there is still disputed
Received 9 May 2018
Revised 1 September 2018
8 October 2018
25 January 2019
21 April 2019
11 May 2019
Accepted 17 May 2019
This research received no specific
grant from any funding agency in
the public, commercial or not-for-
profit sectors. The author thanks
the comments and feedback of
the two anonymous reviewers.
Ereny Gobrial is based at the
Department of Mental Health,
Faculty of Education, Zagazig
University, Zagazig, Egypt.
DOI 10.1108/AMHID-05-2018-0026 © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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research findings whether comorbid MHD are higher or not among individuals with ID and ASD than
without ASD. Some epidemiological studies suggested that comorbid MHD occur at particularly
higher rates in children and young people with ID and ASD compared with other children with ID but
without ASD (Gadow et al., 2004; Brereton et al., 2006; Herring et al., 2006; Gillberg and Fernell,
2014). The study by Bradley et al. (2004) illustrated that adolescents and young people diagnosed
with ASD and severe ID reported higher prevalence rates of psychiatric and behaviour disorders than
those without ASD, although Melville et al. (2008) indicated that there are no differences in prevalence
or incidence of either mental ill-health or problem behaviours in adults with ASD and ID compared
with individually matched controls with ID but without ASD.
This is of great concern considering that comorbidity of ID and ASD suggests an increased risk
for comorbid psychopathology. The vulnerability to comorbid MHD the case may be due to the
core features of ID and ASD that can pose risks to children’s mental health. For instance, low
intellectual and communication ability, lack of social and cognitive resources and poor coping
skills might affect the increased prevalence rates of MHD (Deudney and Shah, 2004; Wilson et al.,
2005; Smiley, 2005). Low intellectual ability and poor cognitive skills are more likely to lead to poor
self-esteem and, in turn, increased vulnerability to anxiety disorder. Likewise, poor coping skills
are associated factor, as unfamiliar problem-solving tasks for children with ASD could contribute
to anxiety and depression disorders (Henry and Crabbe, 2002).
These comorbid disorders may add further impairments to individuals with ID and ASD and are
substantially more prevalent compared to neurotypical populations (Matson and
Nebel-Schwalm, 2007; Simmonoff et al., 2008; Mannion et al., 2014). The multimorbidity of ID
and ASD and overlapping conditions interfere with interpersonal skills, school performance,
family relationships and cognitive ability (Rommelse et al., 2010). Experiencing MHD can be
disabling for children and young people with ID and ASD, resulting in negative consequences for
them and their families. MHD often cause more distress to caregivers than the core features of the
ID and ASD (Hastings et al., 2006; Lecavalier et al., 2006). Research shows that parents of
children and young people with ASD are more likely to be stressed or depressed compared to
other parents (Heiman and Berger, 2008; Fido and Al Saad, 2013; Omar et al., 2017).
Furthermore, because of discrimination and stigma surrounding disabilities lead many families in
Egypt to be socially isolated and not engaged in any social activities and often keep their child at
home (Gobrial, 2018a). Accordingly, those children who are socially isolated and lack important
support systems are more likely to experience MHD. Comorbid ID and ASD presents with
multimorbidity and developmental delay require assessment and intervention.
While there has been an abundance of research investigating comorbid MHD in individuals with
ID and ASD, very little literature available in Egypt focused on the comorbid MHD in children with
ID and ASD. In a sample of children with ASD recruited from three Arab countries Egypt, Saudi
Arabia and Jordan, Amr et al. (2011) indicated that 63 per cent of the children are diagnosed with
at least one comorbid disorder. The most commonly reported comorbid disorders were anxiety
disorders (58.3 per cent), ADHD (31.6 per cent), conduct disorders (23.3 per cent) and major
depressive disorders (13.3 per cent).
The increasing number of individuals with ID and ASD and comorbid MHD present a key
challenge to their assessment and treatment in mental health services. The comorbidity in
children and young people with ASD may have important consequences on their overall well-
being in both the immediate and longer term as well as impact on their family well-being (Weiss
et al., 2014). Early detective of the comorbid MHD and significant behaviours (SB) at any point in
the child’s development is vital regard treatment and early intervention. Thus, identifying
comorbidities is considered a crucial point for treatment, services needed and medical support.
Delaying assessment and intervention to children with ID and ASD increases the impact of the
condition and the challenges involved in service provision and support. To date, there are no
prevalence studies of comorbid MHD in children with ID and ASD in Egypt.
Given that previous studies have reported high prevalence of comorbid MHD with individuals with
ID and ASD and the scarce literature on the prevalence of comorbid disorders with ID and ASD in
Egypt, to the best of the author’s knowledge, the main aim of this study was to investigate the
prevalence of comorbid MHD and SB among children with ID and ASD in an Egyptian sample.
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Method
Participants
The current study included 222 children and young people with mild to moderate ID (50≥IQ ≥70).
These were drawn from a pool of pupils who were attending special education schools, private
schools and day care centres (a special needs day nursery for children with disabilities), located in
Sharkiya and Cairo governorates in Egypt. There were approximately 500 pupils who were enroled
in the above services and were expected to have an ID, ASD or ID and ASD. All the participants’
scores met cut-off point for ASD according to the childhood autism rating scale (CARS) (Schopler
et al., 1986) and IQ assessment using the Stanford Binet intelligent scale assessed by an expert
clinical psychologist, based on their school records. The eligible participants for this study were all
children classified as having both ID and ASD. Children classified as having an ID (without ASD) or
ASD (without ID) were excluded.
All parents and teachers who expressed interest and had children or young person that fulfilled
the eligible criteria were involved in this study. In total, 222 children and young people aged
5−20 years, with a mean age of 12.34 years (SD ¼3.64) were involved. The majority of the
participants were male 75.6 per cent (n¼168), while 24.4 per cent (n¼54) were female. Parents
and teachers completed the Reiss scale for children’s dual diagnosis based on their best
knowledge of those children. Participants’characteristics are presented in Table I.
Instruments
The Reiss scale for children’s dual diagnosis (Reiss and Valenti-Hein, 1990) was applied in this
study to measure the comorbid MHD. The Reiss was translated into Arabic and adapted to an
Egyptian population. The scale consists of 60 items that ask parents to report on the frequency of
which an item is true for their children. The 60 items are organised into ten psychometric subscales,
that each item on the scale is presented in three parts: the name of the symptoms, a non-technical
definition and common behavioural examples. Each item is rated on a three-point scale from 0 “not
a problem”,1“problem”to 2 “major problem”. This is a screening tool to determine if a child or a
young person with ID has comorbid MHD, which reflects the severity of psychopathology.
Table I Sample characteristics
Sample size n ¼222
Gender
Male n¼168 (75.6%)
Female n¼54 (24.4%)
Children (5–12 years) n¼109
Young people (13–20 years) n¼113
Mean age (SD) 12.34 years (SD ¼3.64)
Gender
Male 12.23
Female 12.69
+Ve Mental health disorders n ¼138 (62.2%)
Gender
Male n¼107 Mean ¼34.52 (SD ¼17.4)
Female n¼31 Mean ¼32.92 (SD ¼17.2)
Age
Children n¼68
Young people n¼70
Significant behaviour n ¼144 (64.8%)
Gender
Male n¼106 Mean ¼4.4
Female n¼38 Mean ¼4.3
Age
Children n¼82
Young people n¼62
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The Arabic adapted version of the Reiss scale was validated in an Egyptian population of children
with ID and ASD (Gobrial, 2018b). The Arabic version of the Reiss scale has shown good reliability
using SPSS-24 for Windows, Cronbach’sαwas (0.916) and Pearson correlation between the
behaviour disorders’score and the overall score was (0.817).
Procedures
Ethical approval was obtained from the university ethical committee of Zagazig University.
Parents were recruited from a variety of sources including contact with special education schools
and private day care centres from the Sharkiya and Cairo governorates, Egypt. Letters were sent
to parents of the children and young people with ID and ASD through the schools and the other
service users of day care centres. Parents and teachers of the 97 children and young people
from five different schools, who expressed interest, participated in this study. In addition to this,
125 parents were also recruited from different private day care centres. Consent was sought
successfully from all participants. The Reiss scale for children’s dual diagnosis was applied to
screen for MHD in children and young people with ID and ASD. This was administered by parents
and teachers in the present study for each participant.
Analysis
Statistical analyses were performed with SPSS version 24.0. Descriptive statistics were used to
present the findings. The cut-off points (29) were used to identify children and young people who
scored at or above the cut-off score for MHD. According to the Reiss scale test manual, a child
was considered to test “positive”for MHD if one or both of the following conditions were true: the
total score is 29 or higher; at least two of the ten psychometric scales are at or above
the suggested cut-off points.
Prior to analysis, the data were screened for normality. A Kolmogorov–Smirnov test ( po0.05) and
a visual inspection of their histograms showed that the Reiss scores were not evenly distributed for
both males and females. The Spearman correlation was used to compare the MHD of male to
female on Reiss. The association of age and comorbid disorders were analysed by using χ
2
tests.
χ
2
test was also used to investigate differences between the Reiss score and SB.
Results
The present study screened 222 children and young people with ID and ASD for comorbid MHD
and other SB in Egypt. As illustrated in Table II, the findings showed high prevalence rates of MHD
among children and young people with ID and ASD, 138 out of 222 (62.2 per cent) were scored
positive for MHD based on the total score criteria of the Reiss scale. The highest incidence was
for anger, psychosis and anxiety disorders, while the lowest was for poor self-esteem. In relation
to the gender, 63.7 per cent (107/168) of males tested positive and 57.4 per cent (31/54) of
females tested positive.
Table II Descriptive statistics, number and percentage of individuals tested positive on
Reiss and each psychiatric disorder
Category Mean SD Total No. %
Anger 5.92 2.856 90 40.5
Anxiety 4.06 2.314 76 34.2
Attention deficit 3.58 2.272 60 27
Autism 4.81 2.492 51 22.9
Conduct disorder 3.33 2.757 47 21
Depression 3.26 2.307 39 17.5
Poor self-esteem 2.97 2.194 20 9
Psychosis 4.49 2.470 79 35.5
Somatoform behaviour 1.89 2.297 23 10.3
Withdrawn 4.65 2.596 63 28.4
+Ve Mental health Total Reiss (severity) 34.13 17.428 138 62.2
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Gender, age and the Reiss MHD total score
χ
2
test showed no association between MHD Reiss total score and gender (x
2
¼0.947,
r¼−0.040 at 0.01 level). χ
2
test was also performed to identify the differences between Reiss
score for MHD and age groups (children and young people). Prevalence of MHD did not vary
significantly according to age (x
2
¼−0.091, p¼0.082, at level 0.05, df ¼0.163). The χ
2
analyses
indicated no significant difference between the age groups.
Rates of the significant behaviour
The findings of the current study identified that 64.4 per cent of the sample had associated SB
(see Table I). The most common SB were involuntary motor movement (12.6 per cent); pica
(11.2 per cent), followed by crying spells (10.3 per cent). The less common behaviours were set
fires (1.8 per cent), as shown in Table III. The findings showed that there were more prevalence
rates of behaviour disorders in children that attended primary school 75.2 per cent (n¼82/109)
than in children in secondary school 54.8 per cent (n¼62/113).
Association between mental health disorders and significant behaviour
The findings illustrated that 48.2 per cent of the participants were identified with both positive
MHD and associated SB (see Figure 1). Crying spells and verbal abuse were most presented
with anxiety and anger disorders, 25 per cent of those with anger and 16 per cent of children with
anxiety had crying spells. Findings of the Spearman correlation test (r¼0.691, p¼0.000, at level
0.01, df ¼0.036) indicated no significant statistical correlation between Reiss score of MHD and
SB among the participates.
Discussion
The results of this study indicated high prevalence rates (62.2 per cent) of comorbid MHD among
children and young people with ID and ASD, of which 48.3 per cent were male and 13.9 per cent
were female. The findings are consistent with earlier research concerning children and
adolescents who have ID and ASD in other countries that have also demonstrated high
prevalence rates of comorbid MHD (Berney, 2000; Le Couteur, 2003; Bishop, 2010; Gillberg and
Fernell, 2014). However, the current findings are higher than other studies which reported a
30–33 per cent prevalence of MHD in young children with ASD (Green et al., 2005; Hartley and
McCoy, 2008).
The comorbidity with MHD such as withdrawn, attention deficits, anxiety, psychosis and
depression have shown as highly prevalent in children and young people with ID and ASD; this is
in accord with previously published research (White et al., 2009; Levy et al., 2010; Mayes et al.,
2011; Gobrial and Raghavan, 2012). The current findings indicate that anger and anxiety are the
Table III Number and percentage of individuals tested positive on each significant
behaviour
Other significant behaviours (SB) No. %
Significant behaviours 144 64.8
1. Crying spells 23 10.3
2. Enuresis 21 9.5
3. Hallucinations 12 5.4
4. Involuntary motor movement 28 12.6
5. Lies 21 9.5
6. Obese 11 5
7. Pica 25 11.2
8. Sets fires 4 1.8
9. Sexual problem 9 4
10. Verbally abusive 14 6.3
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most marked comorbid psychopathology among children and young people with ID and ASD in
Egypt. This is in line with the literature previously reported for children with ID and ASD (Amr et al.,
2011; Mayes et al., 2011; Gobrial and Raghavan, 2012). Anxiety has seen as the biggest
comorbidity in ID and ASD (Tantam, 2014) as well as anger (Gobrial and Raghavan, 2012). It is
recognised that emotional problems occur frequently in young people with ID and ASD in
consequence of the symptoms of the ASD (Leyfer et al., 2006), as illustrated earlier in the
introduction. The Reiss scale may have clinical utility and aid clinical decision making.
The findings indicate that the prevalence of MHD did not vary significantly according to age.
These findings are consistent with Tsakanikos et al. (2011) revealing that there were no significant
differences in age among adults with ID and ASD. Although, the findings reported that some MHD
such as anger and withdrawal were more common among younger children. However,
prevalence rates of anxiety and depression are higher among the older age group. This concurs
with previous research which indicated that some comorbid disorder rates, including anxiety and
depression, increase with age (Mayes et al., 2011; Gobrial and Raghavan, 2012).
With respect to gender, the findings reveal that there are no associations between comorbidity
and gender in line with other studies (e.g. McCarthy et al., 2010) and differ from other studies (e.g.
Tsakanikos et al., 2011) which reported adults male with ASD were more likely to have comorbid
psychopathology and clinical management.
With respect to the associated SB, the current findings reported that SB were shown in
64.4 per cent of the participants. However, this is higher than other studies which reported
44 per cent of behaviour disorders (Mattila et al., 2010). The findings suggest that crying spells
and pica were frequently co-occurring with anxiety and anger among children and adolescents
with ID and ASD. Perhaps underlying ASD symptoms such as lack of social understanding
or the discomfort associated with breaking a routine are attributed to these behaviours
(Autism Speaks, 2012). This, in turn, may promote crying spell behaviours. However, it is not
clear whether these results specifically related to the comorbid MHD or to the core features
of ASD (McCarthy et al., 2010). Literature suggests that pica is relatively common in children
with ASD (Matson et al., 2013).
Implications and limitation
This study has many implications. First, assessment on Reiss scale is cost effective and
helps in making appropriate decisions regarding further evaluations, interventions and referrals.
Figure 1 Age groups and gender with comorbid Mental health disorders and significant
behaviour
0
10
20
30
40
50
60
70
80
90
Children Young People Total
Male [VALUE]
Male [VALUE]
Male
[VALUE]
Female
[VALUE]
Female
[VALUE]
Female
[VALUE]
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Second, mental health assessment will help to highlight the need for this vulnerable group and
develop appropriate services. A great deal of research is needed to determine how best to
assess and treat these disorders within the context of ASD. Further research is warranted to
better understand the common comorbidities, behaviours and associated risk factors. Future
studies which could determine what interventions are effective in reducing comorbid MHD in
children and young people with ID and ASD merit attention. Investigating the impact of comorbid
disorders and associated behaviour disorders in children and young people with ASD and ID
should be investigated. In Egypt, there is lack of specialist child ID mental health services and lake
of assessment and diagnostic tool that is validated in the Arabic language and adapted to
Egyptian culture. The current study used Reiss scale of children’s dual diagnosis, a validated
measure of comorbid mental health that has been validated on an Egyptian sample. This is the
first reliable and valid measurement of MHD that has been validated in Arabic for children with ID
and ASD.
Limitations of this study should also be pointed out. The small sample size and the limited
demographic area in recruiting participants of children with ID and ASD need to be solicited
from a countrywide representative sample for generalisation and transferability of the findings.
Future research might investigate the prevalence of comorbidity with ID and ASD on a larger
sample. The current screening was limited to children and young people with mild/moderate ID
and ASD. The assessment of the comorbid disorders in children with ID and ASD requires
further investigation.
Conclusion
This study indicates the high prevalence rates of comorbid MHD and SB in children and young
people with mild to moderate ID and ASD in Egypt. The results support common prevalence
(62.2 per cent) of comorbid disorders in ID and ASD. The comorbid disorders with ID and ASD will
increase the burden on the parents and affect family well-being. All of this highlights the
importance of screening for MHD in children and young people with ID and ASD. There is a
tremendous need for psychologists to be able to provide assessments of comorbid MH with ID
and ASD and provide appropriate interventions to address these disorders. This will have a
positive impact not only on the children but also their parents and consequently improve family’s
well-being.
References
Amr, M., Raddad, D., El-Mehesh, F., Bakr, A., Sallam, K. and Amin, T. (2011), “Comorbid psychiatric
disorders in Arab children with Autism spectrum disorders”,Research in Autism Spectrum Disorders, Vol. 6
No. 1, pp. 240-8.
Autism Speaks (2012), “Challenging behaviour tool kit”, Autism Speaks, available at: AutismSpeaks.org
(accessed 30 November 2018).
Berney, T. (2000), “Autism- an evolving concept”,The British Journal of Psychiatry, Vol. 176 No. 1, pp. 20-5.
Bishop, D. (2010), “Forty years on: Uta Frith’s contribution to research on autism and dyslexia, 1966-2006”,
Quarterly Journal of Experimental Psychology, Vol. 61 No. 1, pp. 16-26.
Bradley, E.A., Summers, J.A., Wood, H.L. and Bryson, S.E. (2004), “Comparing rates of psychiatric and
behaviour disorders in adolescents and young adults with severe intellectual disability with and without
autism”,Journal of Autism and Developmental Disorders, Vol. 34 No. 2, pp. 151-61.
Brereton, A.V., Tonge, B.J. and Einfeld, S.L. (2006), “Psychopathology in children and adolescents with
autism compared to young people with intellectual disability”,Journal of Autism and Developmental
Disorders, Vol. 36 No. 7, pp. 863-70.
De Bruin, E., Ferdinand, R., Meester, S., de Nijs, P. and Verheij, F. (2007), “High rates of psychiatric
co-morbidity in PDD-NOS”,Journal of Autism and Developmental Disorders, Vol. 37 No. 5, pp. 877-86.
Deudney, C. and Shah, A. (2004), Mental Health in People with Autism and Asperger’s Syndrome: A Guide
For Health Professionals, National Autistic Society, London.
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
Downloaded by Doctor Ereny Gobrial At 03:00 04 July 2019 (PT)
Einfeid, S.L., Ellis, L.A. and Emerson, E. (2011), “Comorbidity if intellectual disability and mental disorder in
children and adolescents: a systematic review”,Journal of Intellectual and Developmental Disability, Vol. 36
No. 2, pp. 137-43.
Emerson, E. and Hatton, C. (2007), “Mental health of children and adolescents with intellectual disabilities in
Britain”,British Journal of Psychiatry, Vol. 19 No. 6, pp. 493-9, doi: 10.1192/bjp.bp.107.038729.
Fido, A. and Al Saad, S. (2013), “Psychological effects of parenting children with autism prospective study in
Kuwait”,Open Journal of Psychiatry, Vol. 3 No. 2A, pp. 5-10.
Gadow, K., Devincent, C.J., Pomeroy, J. and Azizian, A. (2004), “Psychiatric symptoms in preschool children
with PPD and clinic and comparison samples”,Journal of Autism and Developmental Disorders, Vol. 34 No. 4,
pp. 379-93.
Gillberg, C. and Fernell, E. (2014), “Autism plus versus autism pure”,Journal of Autism and Developmental
Disorders, Vol. 44 No. 12, pp. 3274-6.
Gobrial, E. (2018a), “The Lived experiences of mothers of children with the autism spectrum disorders in
Egypt”,Social Science, Vol. 7 No. 8, p. 133.
Gobrial, E. (2018b), The Mental Health Disorders Scale for Children and Adolescents with Intellectual
Disabilities: Translation and Adaptation into Arabic, The Anglo Egyptian Bookshop, Cairo.
Gobrial, E. and Raghavan, R. (2012), “Prevalence of anxiety disorder in children and young people with
intellectual disabilities and autism”,Advances in Mental Health and Intellectual Disabilities, Vol. 6 No. 3,
pp. 130-40.
Green, H., McGinnity, A., Meltzer, H., Ford, T. and Goodman, R. (2005), Mental Health of Children and Young
People in Great Britain, 2004, Palgrave Macmillan on behalf of National Statistics, Basingstoke.
Hartley, L. and McCoy, S. (2008), “Prevalence and risk factors of maladaptive behaviour in young children with
autistic disorder”,Journal of Intellectual Disability Research, Vol. 52 No. 10, pp. 819-29.
Hastings, R., Daley, D., Burns, C. and Beck, A. (2006), “Maternal distress and expressed emotion: cross-
sectional and longitudinal relationships with behaviour problems of children with intellectual disabilities”,
American Journal of Mental Retardation, Vol. 111 No. 1, pp. 48-61.
Heiman, T. and Berger, O. (2008), “Parents of children with Asperger’s syndrome or with learning
disabilities: family environment and social support”,Research in Developmental Disabilities, Vol. 29 No. 4,
pp. 289-300.
Henry, F. and Crabbe, M.D. (2002), “Treatment of anxiety disorders in persons with mental retardation”,in
Dosen, A.A. and Day, K. (Eds), Treating Mental Illness and Behavior Disorders in Children and Adults With
Mental Retardation, American Psychiatric Press, Washington, DC, p. 227.
Herring, S., Gray, K.J., Tonge, T.B., Sweeney, D. and Einfeld, S. (2006), “Behaviour and emotional problems
in toddlers with pervasive developmental disorders and developmental delay: associations with parental
mental health and family functioning”,Journal of Intellectual Disability Research, Vol. 50 No. 12, pp. 874-82.
Hughes-McCormack, L., Rydzewska, E., Henderson, A., MacIntyre, C., Rintoul, J. and Cooper, S.A. (2017),
“Prevalence of mental health conditions and relationship with general health in a whole-country population of
people with intellectual disabilities compared with the general population”,British Journal of Psychiatric Open,
Vol. 3 No. 5, pp. 243-8.
Lecavalier, L., Leone, S. and Wiltz, J. (2006), “The impact of behavior problems on caregiver stress
in young people with autism spectrum disorders”,Journal of Intellectual Disability Research, Vol. 50 No. 3,
pp. 172-1.
Le Couteur, A. (2003), National Autism Plan for Children (NAPC)’, National Initiative for Autism: Screening and
Assessment, The National Autistic Society, London.
Lever, A.G. and Geurts, H.M. (2016), “Psychiatric co-occurring symptoms and disorders in young, middle-
aged, and older adults with autism spectrum disorder”,Journal of Autism and Developmental Disorders,
Vol. 46 No. 16, pp. 1916-30, available at: https://doi.org/10.1007/s10803-016-2722-8
Levy, S.E., Giarelli, E., Lee, L.C., Schieve, L.A., Kirby, R.S., Cunniff, C., Nicholas, J., Reaven, J. and Rice, C.E.
(2010), “Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions
among children in multiple populations of the United States”,Journal of Developmental and Behavioral
Pediatrics, Vol. 31 No. 4, pp. 267-75, doi: 10.1097/DBP.0b013e3181d5d03b.
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
Downloaded by Doctor Ereny Gobrial At 03:00 04 July 2019 (PT)
Leyfer, O.T., Folstein,S.E., Bacalman, S., Davis, N.O., Dinh, E., Morgan, J., Tager-Flusberg, H. and Lainhart, J.E.
(2006), “Comorbid psychiatric disorders in children with autism: interview development and rates of disorders”,
Journal of Autism and Developmental Disorders, Vol. 36 No. 7, pp. 849-61.
McCarthy, J., Hemmings, C., Kravariti, E., Dworzynski, L., Holt, G., Bouras, N. and Tsakanikos, E. (2010),
“Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism
spectrum disorders”,Research in Developmental Disabilities, Vol. 31 No. 2, pp. 362-6.
Mannion, A., Brahm, M. and Leader, G. (2014), “Comorbid psychopathology in autism spectrum disorder”,
Review Journal of Autism and Developmental Disorders, Vol. 1 No. 2, pp. 124-34, doi: 10.1007/s40489-
014-0012-y.
Matson, J.L. and Nebel-Schwalm, M. (2007), “Comorbid psychopathology with autism spectrum disorder in
children: an overview”,Research in Developmental Disabilities, Vol. 28 No. 4, pp. 341-52.
Matson, J.L., Hattier, M.A., Belva, B. and Matson, M.L. (2013), “Pica in persons with developmental
disabilities: approaches to treatment”,Research in Developmental Disabilities, Vol. 34 No. 9, pp. 2564-71.
Mattila, M., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., Linna, S., Ebeling, H.,
Bloigu, R., Joskitt, L., Pauls, D.L. and Moilanen, I. (2010), “Comorbid psychiatric disorders associated with
Asperger syndrome/high-functioning autism: a community and clinic-based study”,Journal of Autism and
Developmental Disorder, Vol. 40 No. 9, pp. 1080-93.
Mayes, S.D., Calhoun, S.L., Murray, M.J. and Zahid, J. (2011), “Variables associated with anxiety
and depression in children with autism”,Journal of Developmental and Physical Disabilities, Vol. 23 No. 4,
pp. 325-37, doi: 10.1007/s10882-011-9231-7.
Melville, C.A., Cooper, S.A., Morrison, J., Smiley, E., Jackson, A., Finlayson, J. and Mantry, D. (2008),
“The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities”,Journal of
Autism and Developmental Disorders, Vol. 38 No. 9, pp. 1678-88.
Munir, K. (2016), “The co-occurrence of mental disorders in children and adolescents with intellectual
disability/intellectual developmental disorder”,Current Opinion in Psychiatry, Vol. 29 No. 2, pp. 95-102.
Omar, T., Ahmed, W. and Basiouny, N. (2017), “Challenges and adjustments of mothers having children with
autism”,Alexandria Journal of Paediatrics, Vol. 30 No. 3, pp. 120-9.
Parr, J., Le Couteur, A., Baird, G., Rutter, M., Pickles, A., Fombonne, E. and Bailey, A. (2011), “Early
developmental regression in autism spectrum disorder: evidence from an international multiplex sample”,
Journal of Autism and Developmental Disabilities, Vol. 41 No. 3, pp. 332-40.
Reiss, S. and Valenti-Hein, D. (1990), Reiss Scales for Children’s Dual Diagnosis: Test Manual, IDS Publishing,
Chicago.
Rommelse, N., Franke, B., Geurts, H., Hartman, C. and Buitelaar, J. (2010), “Shared heritability of attention-
deficit/hyperactivity disorder and autism spectrum disorder”,European Child and Adolescent Psychiatry,
Vol. 19 No. 3, pp. 281-95.
Salazar, F., Baird, G., Chandler, S., Tseng, E., O’Sullivan, T., Howlin, P., Pickles, A. and Simonoff, E. (2015),
“Co-occurring psychiatric disorders in preschool and elementary school-aged children with autism spectrum
disorder”,Journal of Autism and Developmental Disorders, Vol. 45 No. 8, pp. 2283-94.
Schopler, E., Reichiler, R.J. and Renner, B.R. (1986), The Childhood Autism Rating Scale (CARS): for
Diagnostic Screening and Classification of Autism’, Irvington, New York, NY.
Simmonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T. and Baird, G. (2008), “Psychiatric disorders
in children with autism spectrum disorders: prevalence, comorbidity and associated factors in a population-
derived sample”,Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 47 No. 8,
pp. 921-9.
Smiley, E. (2005), “Epidemiology of mental health problems in adults with learning disability: an update”,
Advances in Psychiatric Treatment, Vol. 11 No. 3, pp. 214-22.
Tantam, D. (2014), “Autism, anxiety and OCD. Network Autism”, available at: http://network.autism.org.uk/
knowledge/insight-opinion/professor-digby-tamtum-autism-anxiety-and-ocd (accessed 15 December 2017).
Tsakanikos, E., Underwood, L., Kravariti, E., Bouras, N. and Mccarthy, J. (2011), “Gender differences in co-
morbid psychopathology and clinical management in adults with autism spectrum disorders”,Research in
Autism Spectrum Disorders, Vol. 5 No. 2, pp. 803-8.
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
Downloaded by Doctor Ereny Gobrial At 03:00 04 July 2019 (PT)
Weiss, J., Wingsiong, A. and Lunsky, Y. (2014), “Defining crisis in families of individuals with autism spectrum
disorders”,Autism, Vol. 18 No. 8, pp. 985-95.
White, S.W., Oswald, D., Ollendick, T. and Scahill, L. (2009), “Anxiety in children and adolescents with autism
spectrum disorders”,Clinical Psychology Review, Vol. 29 No. 3, pp. 216-29.
Wilson, A., Jahoda, A., Stalker, K. and Cairney, A. (2005), “What’s happening? How young people with
learning disabilities and their family carers understand anxiety and depression”, in Foundation for people with
LD (Ed.), Making Us Count, Mental Health Foundation, London, pp. 37-61.
Corresponding author
Ereny Gobrial can be contacted at: ereny.gobrial@hotmail.co.uk
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