“People with special needs need really special services.”
This line, from a training I took at the beginning of my career about stereotypes regarding behavioral health and people with intellectual/developmental disabilities (IDD), was haunting me. I had been out of graduate school for only a few months and gotten a position at North Range Behavioral Health, working with individuals who were participating in services provided by Envision. I felt I was in over my head; my classes in graduate school had only barely touched on developmental disabilities and that was to explain how IQ scores placed people in categories – and the Diagnostic and Statistical Manual of Medical Disorders still used the “R word.” Most of my experience was based on working with folks with IDD through volunteering with Special Olympics and Best Buddies in college.
When I started my position, I believed that to be a good therapist to people with special needs I needed to be “really special” and have skills specific to serving that population. I also believed the myth that it was rare for those with intellectual and developmental disabilities to have behavioral health issues and if they did, they rarely benefitted from therapy.
Luckily, I did more research.
Behavioral health problems are actually more common for people with intellectual disabilities than they are for the general population. However, these issues are often overlooked, and concerns like depression, anxiety and other disorders are often mislabeled. When symptoms are even noticed, few therapists, doctors, social workers, and psychologists in our communities have the expertise and confidence to treat the issues. Many clinicians, like myself, have few chances in their trainings to learn what is and isn’t effective.
First and foremost, we need to take it seriously when our friends, family, co-workers and acquaintances who fall into this group talk to us about their feelings and concerns. It’s also important to look out for warning signs of behavioral health problems:
- Drastic changes in appetite or sleep
- Changes in behavior, such as doing worse at school or work or refusing to do things they use to love
- More reported fears of things that hadn’t scared them before
- Thoughts of suicide or hurting themselves
If you see these concerns appear, turn to that individual’s trusted physician or doctor if you know them. If the individual is still in school, a teacher, school psychologist, counselor or social worker can be a great resource. In the community at large, look to case managers at places like Envision, supervisors and advocates at day programs, work crews, and residential agencies.
Addressing the behavioral health problems of people with intellectual disabilities requires the same skills we want all good therapists and doctors to have: empathy, openness, and warmth. It may mean at times rephrasing questions or going about therapy in a different way, such as taking walks or doing an activity during sessions, writing more things down, and using pictures as memory aids.
Be mindful that they may be more inclined to respond in the way that they think you want them to; a lot of individuals with intellectual disabilities have been taught from a young age to be compliant, sometimes so much so that they under-report issues or minimize problems. You may also want to be mindful of how to phrase questions; those using an either/or approach or posing too many options may be confusing to someone with processing issues.
Additionally, I’ve had to watch my language. As someone who often speaks informally and uses colloquialisms, I have had to double check that the person I’m speaking with understands my meaning. As always, we therapists should be careful how much scientific or psychology-specific terms we use.
When taken seriously, spotted early and responded to appropriately, behavioral health concerns can be treated in anyone, even people with disabilities. It is our responsibility to be aware and open to these problems instead of pigeonholing folks based on past stereotypes, lack of knowledge, and misunderstandings.
Whatever your approach, it’s not about “really special services” – it’s about treating people with intellectual disabilities as people first and listening to their hopes, fears, and needs seriously.
Regina Haugland, LPC MA LAC
North Range Behavioral Health