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1. Knowledge Database
• Topic of lecture: Who are These People? A Profile of Patients
and their Families Treated by the Schneider Outpatient Unit
for Developmental Psychiatry
• Lecturer name: Mike Stawski
Schneider Children's Medical Center, Israel
• The lecture was given at the Beit Issie Shapiro’s
6th International Conference on Disabilities - Israel
• Year: 2015 Length of lecture: 12:27 minutes

2. Presentation to BIS Conference,
Tel Aviv, July 2015
Dr. Mike Stawski, M.B., B.S., MRCPsych
The Outpatient Unit for Neurodevelopmental
Psychiatry, Dept. of Psychological Medicine, Schneider
Children’s Medical Center in Israel

3.  The problem
 Available solutions
◦ Non-specialist
◦ Specialist
 A profile of OUDP patients
 Discussion, feedback
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4. ◦ In European countries 2% mild learning disability,
0.35% severe learning disability (Roy et al., 2000)
◦ In Israel about 0.4 % of the general population are
formally (legally) diagnosed
◦ Point prevalence of psychiatric disturbance is from
10% to upwards of 60% (King et al., 1997)
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5.  Generic psychiatry departments
 Schneider Developmental Psychiatry Outpatient Unit
 Beit Issie Shapiro Dual Diagnosis Unit
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6. Werner S., Stawski, M., Y. Polakiewicz, Y. & Levav, I.
(2013). Psychiatrists’ knowledge, training and
attitudes regarding the care of individuals with
intellectual disability, Journal of Intellectual Disability
Research, 57(8), 774–782
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7.  Our findings suggest inadequacy of existing
services.
 The problem is probably with the basic model,
rather just its local implementation.
 There are various options for improving services.
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8.  For children/adolescents with intellectual disability
and additional psychopathology
 Established in 2001
 Psychiatrists and paramedical staff
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9.  To obtain a clinical and demographic profile of the
patients and their families
 To examine the effectiveness of treatment
 To test a number of hypotheses regarding factors
related to the severity of behavioural/psychiatric
disturbance
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10. 1. The OUDP Demographic Questionnaire
2. The Aberrant Behaviour Checklist (ABC)
3. The Family Assessment Device (FAD) General
Functioning subscale
4. The 12- item General Health Questionnaire (GHQ-12)
5. Vineland Adaptive Behavior Scales, Second Edition
(Vineland-II)
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11.  Assessments were performed zero (T1), four (T2),
eight (T3), and twelve months (T4) after intake
 Vineland Questionnaire only at intake
 Satisfaction Questionnaire only at twelve months
 Other measures at every time point
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12.  “Behavioural problems”/ “violence” - 34%
 “Hyperactivity” - 24%
 “Social withdrawal”- 8%
 “Obsessive-compulsive behaviour” - 6%
 Various other complaints - 28%
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13.  High rate of physical disability, often more than one
 CP / other motor impairment - 44%
 Epilepsy - 33%
 Visual impairment - 22%
 Other physical disability - 18%
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14.  Prior psychotropic medication - 78%
 Types:
◦ Antipsychotics - 33%
◦ Stimulants - 22%
◦ Other - 22
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15.  None - 74%
 Psychotherapy - 12%
 Other kind of non-medical treatment - 14%
 Behavioural therapy - none
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16. For those patients for whom level of ID could be
ascertained:
 Mild - 51%
 Moderate - 28%
 Severe - 16%
 Profound - 5%
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17.  PDD - 33%
 Externalizing disorders (hyperkinetic disorder or
conduct disorder) – 30%
 Internalizing disorders (OCD, other anxiety disorders,
selective mutism, depressive disorder, PTSD) - 18%
 Various other - 18%
 No disturbance - 3%
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18.  ABC Irritability scale score - 17.6, (SD 11.5 ), i.e. 1 SD
over the mean of a “normative” sample, i.e.
“significant behavioural problems”
 ABC stereotypy scale score - 6.0, (SD 7.2 ) i.e. 1 SD
over the mean of a “normative” sample, i.e.
“significant behavioural problems”
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19.  Antipsychotics - 20% of cases
 Stimulants - 25%
 Other medication - 18%;
 No medication - 38%
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20.  Individual psychotherapy – 10%
 Family therapy / work with parents - 56%
 Behavioural therapy - 34%
 Other non-medical recommendations - 5%
 None - 21%
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21. Level of adaptive behavior relative to age (assessed
by Vineland Adaptive Behavior Scales) would be
negatively correlated with behavioral problems
(assessed by ABC scale scores)
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22.  Vineland score correlated negatively with
◦ ABC irritability scale score (Spearman's rho= -.35,
p=.025)
◦ ABC lethargy scale score (Spearman's rho= -.40, p=.009)
◦ ABC stereotypy scale score (Spearman's rho= -.41,
p=.007)
 i.e., the lower the relative adaptive behaviour level of
child, the higher the irritability, lethargy and stereotypy
scale scores
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23. Level of adaptive behavior relative to age (assessed
by the Vineland Adaptive Behavior Scales) would
correlate negatively with level of parental
disturbance (assessed by GHQ-12)
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24. Relative level of adaptive behaviour was
significantly correlated with mothers’ mental health
problems (Spearman's rho = -.35, p = .048), but not at
all with fathers’ (Spearman's rho= -.07).
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25. Over time, we would see clinical
improvement, i.e., a reduction in behavioral
disturbance (assessed by ABC scale scores)
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26.  Significant improvement on ABC Irritability scale
score on repeated measures ANOVA (F = 46.4, p =
0.025)
 Trend towards significance in improvement on:
◦ ABC Stereotypy scale score (F = 2.62, p = 0.06)
◦ Hyperactivity scale score (F = 1.70, p = 0.18)
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27. Family disturbance (assessed by FAD General
Functioning subscale) would at different time points
correlate positively with parental disturbance
(assessed by GHQ-12)
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28.  FAD General Functioning subscale correlated
positively with maternal GHQ-12 at a significant or
highly significant level at all time points except the
first (at which a positive correlation trending
towards significance was found)
 No such correlation was found for fathers
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29.  79% of respondents were satisfied / very satisfied
with their treatment.
 Parents’ feelings of having been understood by their
therapists were highly significantly correlated with
maternal mental health problems (GHQ-12)!!
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30.  More single - parent families
 High rate of physical disability, often multiple
 “Behavioural problems” / “violence” are the
commonest complaints
 Prior treatment with psychotropics is frequent
 Any other prior treatment is infrequent
 2/3 of diagnoses are accounted for by PDD and
externalizing disorders
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31.  Main problems are in the realms of irritability and
stereotypy
 Families functioning in the “stressed“ range
 We used less antipsychotic, more stimulants, more
non-medical interventions
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32.  The lower the relative adaptive behaviour level of
child, the more irritability, lethargy and stereotypy-
type problems
 Relative level of adaptive behaviour as well as
problems in the realms of irritability, stereotypy
and hyperactivity were correlated with mothers’
mental health problems
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33.  Perceived family functioning is positively correlated
with maternal but not paternal mental health
 Significant improvement in area of irritability over
one year
 Reasonable satisfaction rating
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34.  Clinical sample
 Attrition rate / self-selection
 Non- objective measures
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35.  This is generally a sicker-than-usual population
 This specialist psychiatric clinic uses less
psychotropic medications, less antipsychotics, more
non-medical modes of intervention
 Keep an eye out for parental mental health, gaps
between parents, and family functioning
 We need to find ways of achieving improvement in
areas other than just irritability
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36.  Dual diagnosis is a common and poorly treated
problem
 The nonspecialist psychiatrist needs to keep in
mind non-psychotropic modes of treatment
 Specialist care can be effective and is appreciated
 We need to keep in mind patients' physical and
parents’ mental health, and family functioning
 Be nice to dogs and little children

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