Background to the Research

• Children and young people with intellectual disabilities are at a greater risk of developing a psychiatric disorder than their non-disabled peers. This young and doubly disadvantaged population has been shown to be under-recognized, under-assessed and under-treated in relation to service provision. It has been suggested that schools and teachers could play important roles in rectifying this, through the promotion of positive mental health and the early recognition and screening of young people's problems. However, no information exists regarding teachers' knowledge of the signs and symptoms of these conditions.
• This study explores teachers' knowledge of depression, which has been reported to occur more frequently in young people with intellectual disabilities compared to the non-disabled population.
  

Research Approach

• A postal questionnaire asked teachers working within NI schools for children and young people with severe intellectual disabilities about their knowledge of depression. Thirty-six of an estimated 80 teachers working with this group of young people responded.
  

Main Findings

• The majority of teachers had been working with young people with severe intellectual disabilities for more than 10 years.
• Just less than half of the teachers reported that they had between one and three pupils in their class that displayed 'extreme challenging behaviours'. Two teachers reported that they had one pupil each with an undiagnosed psychiatric disorder, and one teacher had two pupils with an identifiable psychiatric disorder.
• Fifteen teachers had concerns about a pupil in their class being undiagnosed with a mental health problem.
• 86.1% of respondents reported receiving some form of education in relation to challenging behaviour, although this ranged from a half-day workshop to a 3 day course. 58.3% of respondents also indicated using assessment tools for challenging behaviour. Only 1 teacher reported using some from of training in the mental health of young people with intellectual disabilities and none indicated using any form of a mental health screening tool.
• The only significant difference in relation to the mean symptom score of depression was found between the mean number of symptoms listed for depression for the young person without an intellectual disability and the young person with a severe intellectual disability.
• The most frequent symptoms for depression reported by the teachers were loss of energy, sleep problems, social withdrawal and loss of interest in life; many respondents reported few other symptoms.
• Overall, the teachers reported on average 3.97 symptoms for a young person who has a depressive disorder without an intellectual disability; this indicated a lack of knowledge concerning the cluster of symptoms that are required to identify whether a depressive disorder is present.
• Teachers reported a lower range of typical symptoms for young persons with a mild and a severe intellectual disability than for those without an intellectual disability. However, they reported that the young person with the mild intellectual disability was more likely to have 'mood swings' (19.4%) than the young person without an intellectual disability (13.8%). Likewise, the young person with a severe intellectual disability was more likely to have 'appetite problems' (36%) and 'little expression of feelings' (16.6%) than the young person with a mild intellectual disability or without an intellectual disability.
• A few teachers highlighted some of the atypical symtomology that a young person with a mild or severe intellectual disability may also display if they were to have a depressive disorder. Six respondents could not indicate any such signs of depression for a young person with a mild intellectual disability and a quarter of respondents could not do so for a young person with a severe intellectual disability.
• The teachers were significantly more likely to report a higher level of confidence in managing a young person without an intellectual disability than a young person with a severe intellectual disability and with a depressive disorder, and in managing a young person with a mild intellectual disability than a young person with a severe intellectual disability.
  

Conclusions

• Although children and young people with intellectual disabilities are at a greater risk of developing a psychiatric disorder than their non-disabled peers, teachers working within schools lacked the knowledge to recognize such signs and symptoms or to manage this dually diagnosed population.
• These findings are worrying, given that these teachers work closely with a population who are more at risk of developing a psychiatric disorder compared to the non-disabled population, and who are more difficult to detect given their impaired language and conceptual skills.
• A lack of appropriate education and training is suggested to explain the respondents not identifying the typical and atypical signs and symptoms of depression which have been reported in previous studies.
• Training for teachers to work with people with intellectual disabilities and mental health problems could focus upon identifying the difficulties often associated in recognizing and screening this dually diagnosed population, and reflecting upon how psychiatric disorders present in people with intellectual disabilities. Specific education and training are suggested to increase teachers' confidence and thereby promote a positive mental health culture.
• There is a great need to know how schools engage with community intellectual disability services and child and adolescent psychiatric teams in order to develop comprehensive and integrated approaches to service provision.