Communication difficulties

The desires, wants, and needs of individuals with developmental disabilities (DD) are comparable to those of their nondisabled peers. But all too often, extreme communication difficulties interfere with the expression of their needs and, thus, with the attainment of goals. For example, one diagnostic criterion for autistic disorder or other types of pervasive developmental disorder is the presence of impaired language capability.5 This impairment can take the form either of inability to talk or of production of echolalic responses, stereotypic vocalizations, or limited one- or two-word utterances. Individuals with other conditions such as fragile X syndrome, Down syndrome, or mental retardation are also likely to have language difficulties, which can take the form of disfluency, perseverative and tangential language6 or limited linguistic repertories. In fact, a sizable subpopulation of people with developmental disabilities have no functional expressive skills.

Individuals with DD thus can experience frustrating difficulty in expressing their desires, leading to anger when those desires are not met. Anger and frustration can then lead to new forms of communication, such as self-injury or aggression, which become the affected person's primary means of expressing dissatisfaction.

Impulse control deficits

Along with communication difficulties, individuals with DD often have deficits in impulse control and executive functioning.7–9 Deficits in impulse control are exemplified by grabbing things that are wanted, touching things that are attractive, and generally not being able to wait until a more appropriate setting or time for fulfilling desires (e.g., masturbating during a classroom activity). Deficits in executive functioning can severely limit problem-solving skills and lead to persistence of well-learned routines even if they are inefficient or inappropriate. Thus, when confronted with a challenge such as the unavailability of a favorite food, their executive functioning deficits would make it difficult for them to conceive of an appropriate plan or strategy for getting the food. Instead they may scream or engage in self-abuse until they receive attention.

Adapted from: Sudhalter V. Problem behaviors in individuals with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;165–174.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised May 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.