"Anxiety and behavioral problems in people with intellectual disabilities". A guideline for multidimensional diagnostics of anxiety and behavioral problems in patients with intellectual disability: research on process and outcomes

Anxiety disorders are among the most prevalent disorders in the normal
population (Vollebergh et al, 2003). According to Richard et al (2001), anxiety
disorders are even more prevalent among people with Intellectual Disability
(ID) due to the fact that people with ID are more vulnerable to anxiety
disorders than the normal population (Raminez and Lukenbill, 2007). This
vulnerability is related to a multitude of causes, including hereditary
factors, attachment problems, cognitive problems, lack of coping abilities, a
greater incidence of trauma, and life-events (Gullone, 1996; IJzendoorn, 1999;
Wijnroks et al, 2006; Dykens, 2000; Cooray & Bakala, 2005; Sullivan et al,
2007; Levitas & Gilson, 2001; Hastings et al, 2004). Since anxiety problems
have been reported as one of the most common forms of psychological distress
for people with ID, it is essential to focus on the diagnostics of anxiety and
anxiety related behavioral problems (Deb et al, 2001; Emerson 2003). However,
assessing the presence and precise nature of mental health problems - in this
case anxiety - in individuals with ID is a complex process (Mohr & Costello,
2007; Dosen, 2005a). It requires special expertise in the face of atypical
presentation of anxiety complaints and behavioral disturbances, communication
difficulties, and the frequent absence of subjective complaints raised by the
patient (Andries et al, 2003; Evans et al, 2005; Hurley et al, 2003; Emmerson &
Hatton, 2007; Rush et al, 2003 and Sevin, 2003). Also diagnostic overshadowing
- i.e. unusual behavior erroneously ascribed to ID, rather than to a mental
disorder - and lack of diagnostic instruments for this special group present
major barriers to the diagnostics of anxiety problems (Reiss et al, 1994;
Barnhill, 2001).
These problems in diagnostics have major implications for clinical practice.
Most importantly, anxiety and anxiety-related behavioral problems may go
unrecognized and consequently under-diagnosed within the ID patient population.
In such cases, effective treatment is unlikely. Whatever treatment is offered
will only address the signs and symptoms and not the underlying causes of the
problem.

Het doel van het onderzoek is inzicht te verkrijgen in de toepassing van de
richtlijn "Gedragsproblemen door Angst" door zowel proces als uitkomsten van
deze toepassing te bestuderen.

multiple case study

We developed a multidisciplinary guideline based on empirical literature and
existing models (Pruijssers et al., 2008) for the multidimensional diagnostics
of anxiety in patients with ID. In this guideline we pay explicit attention to
the nurses* role in the diagnostic process.

There is no risk