Intellectual Disability and Ill Health: A Review of the Evidence

Citation

O'Hara, J., McCarthy, J. and Bouras, N. (2011), "Intellectual Disability and Ill Health: A Review of the Evidence", Tizard Learning Disability Review, Vol. 16 No. 3, pp. 41-42. https://doi.org/10.1108/13595471111158684

Addressing health inequalities amongst people with learning disabilities continues to be a major policy objective in the UK. Recent evidence published by the Learning Disability Observatory (Emerson and Baines, 2010) has added to the growing evidence base for the UK This book is the second in a series planned by the Association for the Improvement of Mental Health Programmes and adds the further dimensions of an international perspective and detailed reviews of the evidence around major diseases and organ systems. The first book in the series addressed the health needs of people with schizophrenia. Later, books will address the needs of people with dementia, depression and those with problems of alcohol or substance misuse.

The book is divided into three sections each with particular target audiences. The first section looks at health needs and the causes of intellectual disability with an emphasis on public health and preventative measures. It is aimed at policy makers, health authorities and service managers.

It considers the congenital and environmental causes of intellectual disability and how these subsequently increase the likelihood of health problems. There is discussion of the systems issues and failures that result in unequal treatment outcomes and of some of the responses such as health checks and training but this is not a detailed “how to” manual.

The second section is targeted at primary and secondary care clinicians. Each chapter looks at a major disease or organ system and provides a review of the research literature relating to how people with learning disability are affected. There are 12 chapters in total covering everything from infectious diseases to dentition, so it is a comprehensive review. It is a reflection of the evidence base rather than the authors that in most cases it focuses on prevalence and disease mechanisms with less information on treatment. Although the medical or surgical interventions offered are likely to be the same as for the general population, there is perhaps a challenge here for medical and nursing researchers to look at the most effective forms of preparation for treatment, support and rehabilitation for people with intellectual disabilities within their area of expertise.

Section 3 covers disorders of the nervous system and neurodevelopment. It includes mental illness, pervasive developmental disorders, epilepsy, hydrocephalus and neurodegenerative disorders such as dementia. It is aimed at psychiatrists, neurologists, paediatricians and primary care physicians. The approach is the same as the previous sections with the authors reviewing the evidence base. Understandably, there is more discussion of the diagnostic complexities in these areas. There is also a bit more of an evidence base around treatment, particularly in the sections on autism and attention deficit hyperactivity disorder.

Each chapter provides short sections on method and results providing details of search terms and databases searched and the numbers of results found. References are provided at the end of each chapter making it easy to go quickly from the text to the source if you wish.

The editors and authors have done a good job of making this a readable book despite the complex nature of the topics covered, but it is published under Cambridge's medicine imprint and this should be a warning to non‐medical readers to have a good medical dictionary and physiology book to hand.

Although the editors have set their sights on very specific readers the book will be of interest to others. Those who wish to look at intellectual disability in a more global context will find references drawn from a wide range of countries. Learning Disability nurses and others wanting to know more about a particular condition will find it a useful reference because it will direct them to studies specifically related to intellectual disability. It will be of use to those working on health facilitation at the strategic level, because it provides evidence they can use to create presentations that catch the attention of clinicians and commissioners from a number of different fields.

What it does not set out to be is a guide to facilitating the health care of individuals. It is not for those wanting to know how to undertake health action planning or annual health checks. Hospital liaison nurses might find it helps in their work but not as an explanation of their role.

It is a book that most will use as a reference work but it is instructive to read it through because it highlights some of the common difficulties with gathering evidence in intellectual disability. The authors comment on the weaknesses in much of the research, the lack of randomised controlled trials, small sample sizes, differences in the populations studied, etc. The studies may be from a different country and culture. Often, they relate to institutionalised groups. Inclusion and exclusion criteria such as severity of disability may not be clear. Two studies can appear to give contradictory results but may not be truly comparable. Many demonstrate correlation rather than causation. There are examples such as Chapter 12 on neoplasms that show how different approaches to research have led to different understandings of the health needs of the population. Before taking away and using the evidence the reader needs to think about these issues. It is beneficial to have experts, as the chapter authors are, review the studies available but the book also demands a thoughtful and critical reader.

The Association for the Improvement of Mental Health Programmes is an international organisation that aims to improve the care and raise the status of people with mental illness and intellectual disability through academic, theoretical and practical work. This book is a useful contribution to that endeavour. It is a timely publication for the UK, where we are undergoing major changes in the commissioning and provision of health care. This book is one that should have a place on the shelves of the new Public Health Bodies and General Practitioner Consortia.