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  • image Persons diagnosed with Down syndrome (DS) can be at increased risk for medical and psychiatric comorbidities.

  • image In persons with DS, a thorough evaluation is needed to differentiate between depression and Alzheimer disease.

  • image Treatment plans for persons with autism spectrum disorder (ASD) focus on increasing social interactions, improving verbal and nonverbal communication, and minimizing the occurrence or impact of ritualistic, repetitive behaviors and other related mood and behavioral problems (eg, overactivity, irritability, and self-injury).

  • image Many purported pharmacologic and nonpharmacologic treatments for ASD lack objective evidence-based support.

  • image A structured teaching approach focusing on increasing social communication and integration with peers is needed when providing services to persons with ASD.

  • image Nonpharmacologic interventions for sleep disturbances in children with a diagnosis of ASD should be implemented prior to pharmacotherapy considerations.

  • image Psychopharmacologic treatment planning should include monitoring of objective, measurable, medication-responsive target behaviors, and assessment of potential adverse effects is of critical importance when treating behavioral symptoms of ASD, as the response of individuals to medication therapy is highly variable.

  • image The use of Food and Drug Administration-approved medication for off-label indications is an acceptable clinical practice if founded on evidence-based research and informed consent.

  • image The level of impairment in Rett syndrome (RTT) is increasingly associated with the particular genetic mutation involved.

Intellectual disabilities (IDs) can be identified in childhood or adolescence. Current criteria for diagnosis are based on deficiencies in intellectual and adaptive functioning with an onset during the developmental period.1 This diagnosis is made regardless of the presence or absence of concomitant medical or psychiatric disorders. In the case of mild ID, deficiencies may not be apparent in early life. Problems can be noted when the chronologic age of the child and the developmental milestones achieved by peers with similar backgrounds, cultures, socioeconomic status, and psychosocial settings differ significantly.1 These gaps between developmental advances widen as the individual ages. Adaptive functioning deficits pose a number of challenges in treating those with an ID.

Whereas it has been estimated that a psychiatric disorder may beset approximately one-fifth of the general population in the United States,2 the prevalence may range widely from approximately 7% to 97% for persons with an ID, largely a function of diagnostic criteria and study design.3 Similarly, the impact of life events, the stress of these events, and limited coping skills may also contribute.4 Underrecognition of the need for mental health services may be due to a lack of caregiver awareness of psychiatric disorders in persons with IDs and/or insufficient provider training and clinical experience with this population.2 Additional barriers to accurate diagnosis may arise from deficits in adaptive functioning, a mechanism by which individuals effectively manage commonly encountered life demands and independence compared with nondevelopmentally disabled peers.1 Communication deficits are a barrier-specific to this population. Furthermore, problematic behaviors that may arise limit opportunities for those with an ID to experience more social interactions and limit integration ...

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