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  • imagePeople with intellectual and developmental disabilities (IDD) have higher incidence of mental illness and challenging behaviors, with dual diagnoses being common.

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

  • imagePeople with IDD experience high rates of polypharmacy and polypsychotropic medication use. Assessment should include physical disorders, as well as social and environmental factors complicating their care.

  • imagePeople with DS have higher rates of Alzheimer-type dementia. A thorough evaluation is needed to differentiate between depression and Alzheimer disease (AD).

  • imageTreatment 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 challenges (eg, over activity, irritability, and self-injury).

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

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

  • imageNonpharmacologic interventions for sleep disturbances in individuals diagnosed with ASD should be implemented prior to pharmacotherapy considerations.

  • imagePsychopharmacologic treatment planning should include monitoring of objective, measurable medication-responsive target behaviors and assessment of potential adverse effects, which are of critical importance when treating the behavioral challenges of ASD. Furthermore, the response of individuals to pharmacotherapy is highly variable.

  • imageThe use of FDA-approved medication for off-label indications is an acceptable clinical practice if founded on evidence-based research and includes informed consent.


Patient Care Process for Intellectual and Developmental Disabilities



  • Involve the patient and one or more caregivers in this process

  • Patient characteristics such as age, sex, pregnancy status

  • Past medical and psychological history

  • Previous life events (eg, changes in living situation)

  • Social history (tobacco/ethanol, substance use or misuse) and dietary habits

  • Social and community-based activities

  • Current prescription and nonprescription medications and supplements


  • Contraindications to potential medications

  • Psychotropic medication already prescribed

  • Presence of adverse effects from medications

  • Physical causes for challenging behaviors such as constipation, gastroesophageal reflux, seizure, aspiration, pain including dental-related pain, sleeping problems (Table e93-1)

  • Risk or evidence of harm to self, others, or property

  • Frequency of challenging behavior

  • Patient’s preference for a type of therapy if appropriate and identify those involved in the patient’s medication use process


  • Choose medication with the strongest evidence and minimal adverse effects (Table e93-2)

  • Determine potential medication interactions with other medications

  • Use supported decision making, which includes patient preferences, when able

  • Education for patient and caregivers

  • Develop non-medication intervention based on social and personal factors

  • Type of prescription medication insurance and insurance-related regulations in choice of medication


  • Provide patient education to patient and caregiver(s)

  • Work to understand issues related to medication adherence. Choose dosage form that will reduce the likelihood of nonadherence

Follow-up: Monitor and Evaluate*

  • Reduction in frequency and severity of challenging behaviors

  • Presence of adverse effects (...

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