Associated issues

Physical health issues

There are many physical health factors associated with developmental disabilities. For some specific syndromes and diagnoses, these are inherent (such as poor heart function in people with Down syndrome); however lack of access to health services and lack of understanding by medical professionals is also a major contributing factor. People with severe communication difficulties find it difficult to articulate their health needs, and without adequate support and education might not recognise ill health. Epilepsy, sensory problems (such as poor vision and hearing), obesity and poor dental health are over-represented in this population. Life expectancy among people with developmental disabilities as a group is estimated at 20 years below average, although this is increasing with advancements in adaptive and medical technologies, and as people are leading healthier, more fulfilling lives, and some specific diagnoses (such as Freeman-Sheldon syndrome) do not impact on life expectancy.

Mental health issues (dual diagnoses)

Mental health issues, and psychiatric illnesses, are more likely to occur in people with developmental disabilities than in the general population. A number of factors are attributed to the high incidence rate of dual diagnoses:

• the high likelihood of encountering traumatic events throughout their lifetime (such as abandonment by loved ones, abuse, bullying and harassment)
• the social restrictions placed upon people with developmental disabilities (such as lack of education, poverty, limited employment opportunities, limited opportunities for fulfilling relationships, boredom)
• biological factors (such as brain injury, epilepsy, illicit and prescribed drug and alcohol misuse)
• developmental factors (such as lack of understanding of social norms and appropriate behaviour, inability of those around to allow/ understand expressions of grief and other human emotions)

These problems are exacerbated by difficulties in diagnosis of mental health issues, and in appropriate treatment and medication, as for physical health issues.

Abuse and vulnerability

Abuse is a significant issue for people with developmental disabilities, and as a group they are regarded as vulnerable people in most jurisdictions. Common types of abuse include:

• Physical abuse (withholding food, hitting, punching, pushing, etc.)
• Neglect (withholding help when required, e.g., assistance with personal hygiene)
• Sexual abuse
• Psychological or emotional abuse (verbal abuse, shaming and belittling)
• Constraint and restrictive practices (turning off an electric wheelchair so a person cannot move)
• Financial abuse (charging unnecessary fees, holding onto pensions, wages, etc.)
• Legal or civil abuse (restricted access to services)
• Systemic abuse (denied access to an appropriate service due to perceived support needs)
• Passive neglect (a caregiver’s failure to provide adequate food, shelter)

Lack of education, lack of self-esteem and self-advocacy skills, lack of understanding of social norms and appropriate behaviour and communication difficulties are strong contributing factors to the high incidence of abuse among this population.

In addition to abuse from people in positions of power, peer abuse is recognised as a significant, if misunderstood, problem. Rates of criminal offending among people with developmental disabilities are also disproportionately high, and it is widely acknowledged that criminal justice systems throughout the world are ill-equipped for the needs of people with developmental disabilities (as both perpetrators and victims of crime)

Challenging behaviour

Some people with developmental disabilities exhibit challenging behaviour, defined as "culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities". Common types of challenging behaviour include self-injurious behaviour (such as hitting, head butting, biting), aggressive behaviour (such as hitting others, screaming, spitting, kicking), inappropriate sexualised behaviour (such as public masturbation or groping), behaviour directed at property (such as throwing objects and stealing) and stereotyped behaviours (such as repetitive rocking, echolalia or elective incontinence).

Challenging behaviour in people with developmental disabilities may be caused by a number of factors, including biological (pain, medication, the need for sensory stimulation), social (attention-seeking, the need for control, lack of knowledge of community norms), environmental (physical aspects such as noise and lighting, or gaining access to preferred objects or activities) or simply a means of communication. A lot of the time, challenging behaviour is learned and brings rewards, and it is very often possible to teach people new behaviours to achieve the same aims.