Diagnostic Overshadowing of Psychological Disorders in People With Intellectual Disability: A Systematic Review.

Diagnostic overshadowing is a bias in which symptoms of a psychological disorder are falsely attributed to a known diagnosis of intellectual disability. This systematic review evaluated all research on diagnostic overshadowing conducted to date, including dissertations and peer-reviewed journal articles. In total, 25 studies were included in this review. Findings suggest diagnostic overshadowing may not be as ubiquitous as originally believed, with one third of included studies finding no overshadowing. The quality of the evidence was graded as "Low" using the LEGEND tool, with common issues including outdated studies, analogue methodologies, small sample sizes and convenience samples, and inappropriate conducting or reporting of statistical analyses. Implications for the field and recommendations for future research are discussed.

Systematic Review: Recommendations for Rehabilitation in ASD and ID From Clinical Practice Guidelines.

OBJECTIVE: To identify and summarize clinical practice guidelines for autism spectrum disorder (ASD) and intellectual disability (ID) for the Package of Interventions for Rehabilitation for the World Health Organization (WHO). DATA SOURCES: Academic databases, Google Scholar, guideline databases, and professional society websites were searched using the general criteria "ASD/ID" AND "rehabilitation" AND "guideline," restricted to English-only guidelines. STUDY SELECTION: Work group members independently screened titles and abstracts (1952 ASD; 1027 ID) and excluded articles if not (1) a guideline; (2) about rehabilitation; (3) published since 2008; or (4) about ASD/ID. Full-text screening (29 ASD; 5 ID) involved 3 additional exclusion criteria: (1) contained conflict of interest; (2) lacked information on strength of recommendation; or (3) failed the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines (4 ASD: 2 on youth, 1 on adults, 1 on all ages; 2 ID: 1 on challenging behaviors, 1 on mental health) resulted. DATA EXTRACTION: Work group members extracted 524 recommendations (386 ASD; 138 ID) from the guidelines including the level of evidence, diagnostic and age group, recommendation type (assessment, intervention, service), target, and valence. DATA SYNTHESIS: Of the 270 intervention recommendations (212 ASD; 58 ID), only 36 for ASD and 47 for ID were empirically based. Most comprised biomedical (23%), pharmacologic (29%), and psychosocial (21%) interventions for ASD and behavioral (14%), pharmacologic (29%), and psychological (14%) interventions for ID. Intervention recommendations primarily targeted coexisting conditions (56% ASD; 93% ID), whereas core symptoms received much less attention (26% ASD). CONCLUSIONS: Clinical practice guidelines reviewed for ASD and ID primarily contained recommendations based on expert opinion, with the plurality of recommendations relating to pharmacologic treatment. Vital next steps include identifying relevant interventions for inclusion in the WHO Package and continuing to conduct rigorous intervention research, particularly on core symptoms of these conditions, to extend recommendations for high-quality guidelines.

Differences in Youth and Parent Postsecondary Expectations for Youth with Disabilities.

BACKGROUND: Parent expectations are known to be significant predictors of postsecondary outcomes among youth with disabilities. However, little is known about the relationship between parent and youth expectations and their differential prediction of postsecondary outcomes among youth with disabilities. OBJECTIVE: To determine the relationship between parent and youth expectations among students with disabilities in the United States. METHODS: Through analysis of the National Longitudinal Transition Study-2 (NLTS2), we compared wave two parent and youth expectations across disability categories (N=1,940) and explored the extent to which they predicted youth postsecondary outcomes. RESULTS: We identified that parent and youth expectations are related but significantly different, with parents consistently holding less independent expectations than youth. Both parent and youth expectations were identified as significant predictors of postsecondary outcomes, with youth expectations more strongly predicting education and independent living outcomes, and parent expectations more strongly predicting employment and Social Security benefit outcomes. CONCLUSIONS: Transition providers should work with parents and youth to develop collaborative goals and expectations to best support youth with disabilities for independent activities in adulthood.

The Role of Adaptive Behavior and Parent Expectations in Predicting Post-School Outcomes for Young Adults with Intellectual Disability.

This study examined the role of parent expectations and adaptive behavior in predicting outcomes for youth with intellectual disability. A sample of students with intellectual disability were drawn from the National Longitudinal Transition Study-2 for inclusion in this study. Four latent variables were created: demographic factors, adaptive behavior, parent expectations, and post-school outcomes. Structural equation modeling was used to test relationships between these constructs. Results indicated that adaptive behavior was more important than parent expectations in predicting post-school outcomes. Results supported the conclusion that adaptive behavior plays a critical role in post-school success for individuals with intellectual disability and that parent expectations alone were insufficient to ensure positive outcomes for youth with poor adaptive skills. Implications are discussed.