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Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability

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Title: Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability
Language: English
Authors: Erlend Refseth Pedersen, Audny Anke, Silje Marie Tessem, Monica Isabel Olsen, Erik Søndenaa
Source: Journal of Mental Health Research in Intellectual Disabilities. 2025 18(2):181-203.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 23
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Drug Therapy, Adults, Intellectual Disability, Behavior Problems, Check Lists, Foreign Countries, Individual Characteristics, Symptoms (Individual Disorders), Age Differences, Severity (of Disability), Epilepsy, Comorbidity
Geographic Terms: Norway
Assessment and Survey Identifiers: Aberrant Behavior Checklist
DOI: 10.1080/19315864.2024.2447232
ISSN: 1931-5864
1931-5872
Abstract: Background: Concerns arise about overuse of psychotropic medication among people with intellectual disability. This study investigates occurrence of mental health problems, psychotropic medication use, and factors associated with the use of psychotropics in a Norwegian community-based sample. Method: A cross-sectional community-based survey including 197 adults with intellectual disability. The POMONA-15 health indicators, the Aberrant Behavior Checklist-Community and the MPAS-Check were used for the assessment of factors associated with psychotropic medication use. Results: A total of 39% (n = 76) used psychotropic medication, 18% (n = 36) scored above cut-off on mental health screening and 23% (n = 45) reported mental health problems. Use of psychotropic medication was associated with older age, more severe intellectual disability, epilepsy, irritability and reported mental health problems. Conclusion: Psychotropic medication is still widely used, but antipsychotic drugs were used less frequently than previously reported. The use of psychotropics should be carefully evaluated, especially for populations with increased risk of adverse events.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1498339
Database: ERIC
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  Value: <anid>AN0184193810;[5ew6]01apr.25;2025Apr04.03:45;v2.2.500</anid> <title id="AN0184193810-1">Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability </title> <p>Background: Concerns arise about overuse of psychotropic medication among people with intellectual disability. This study investigates occurrence of mental health problems, psychotropic medication use, and factors associated with the use of psychotropics in a Norwegian community-based sample. Method: A cross-sectional community-based survey including 197 adults with intellectual disability. The POMONA-15 health indicators, the Aberrant Behavior Checklist-Community and the MPAS-Check were used for the assessment of factors associated with psychotropic medication use. Results: A total of 39% (n = 76) used psychotropic medication, 18% (n = 36) scored above cut-off on mental health screening and 23% (n = 45) reported mental health problems. Use of psychotropic medication was associated with older age, more severe intellectual disability, epilepsy, irritability and reported mental health problems. Conclusion: Psychotropic medication is still widely used, but antipsychotic drugs were used less frequently than previously reported. The use of psychotropics should be carefully evaluated, especially for populations with increased risk of adverse events.</p> <p>Keywords: Intellectual disability; mental health; challenging behavior; psychotropic medication</p> <hd id="AN0184193810-2">INTRODUCTION</hd> <p>People with intellectual disability have been found to have a higher prevalence of mental health problems than the general population (Cooper et al., [<reflink idref="bib10" id="ref1">10</reflink>]; Hughes McCormack et al., [<reflink idref="bib30" id="ref2">30</reflink>]). Further, mental health problems in people with intellectual disability may often be left undiagnosed (Holden & Gitlesen, [<reflink idref="bib27" id="ref3">27</reflink>]) and reported prevalence rates vary considerably. Whitaker and Read ([<reflink idref="bib64" id="ref4">64</reflink>]) found the rate ranging from 4% to 46%, and Buckles et al. ([<reflink idref="bib9" id="ref5">9</reflink>]) found a range from 14% to 75% in their reviews. These variations might be explained by a number of sampling-related factors, such as composition, size, and living arrangements, as well as the reliability of the assessment (Taylor et al., [<reflink idref="bib58" id="ref6">58</reflink>]). Further, there are variations in the definition and diagnostics of mental health problems in people with intellectual disability (Müller et al., [<reflink idref="bib43" id="ref7">43</reflink>]; Whitaker & Read, [<reflink idref="bib64" id="ref8">64</reflink>]). The MPAS-Check screening instrument used in this study has been described as a user-friendly and sensitive tool for identifying mental health problems in people with intellectual disability (Taylor et al., [<reflink idref="bib58" id="ref9">58</reflink>]) and has been utilized frequently in European countries (Bertelli et al., [<reflink idref="bib5" id="ref10">5</reflink>]). The overall prevalence of mental health problems found by Taylor et al. ([<reflink idref="bib58" id="ref11">58</reflink>]) using the MPAS-Check screening instrument was 20%.</p> <p>A recent systematic review by Mazza et al. ([<reflink idref="bib37" id="ref12">37</reflink>]) found that the pooled prevalence of having a psychiatric disorder among adults with intellectual disability was 34%. The highest prevalence was found for affective disorders (7%), anxiety disorders (6%) and schizophrenia (5%). Medication is utilized to enhance quality of life and overall health. However, people with intellectual disability are at greater risk than the general population of using unspecific and, in some cases, inappropriate psychotropic medication (Axmon et al., [<reflink idref="bib3" id="ref13">3</reflink>]).</p> <p>Psychotropic medication is often defined as medication that affects behavior, mood, thoughts, or perception. Psychotropics are commonly used by people with intellectual disability who have mental health problems or challenging behavior (Tan et al., [<reflink idref="bib56" id="ref14">56</reflink>]). Still, prevalence rates of psychotropic drug use vary widely. A Norwegian study conducted by Holden and Gitlesen ([<reflink idref="bib28" id="ref15">28</reflink>]) found a prevalence of 37%. In another Norwegian study, Hove et al. ([<reflink idref="bib29" id="ref16">29</reflink>]), utilizing data from 2005, reported a higher prevalence of drug use for the nervous system (ATC N) in adults with intellectual disability (50%) than in the general population. Sheehan et al. ([<reflink idref="bib52" id="ref17">52</reflink>]) identified a prevalence of psychotropic medications of 49% in a UK population-based cohort study. A recent review by Song et al. ([<reflink idref="bib53" id="ref18">53</reflink>]) found a pooled prevalence of psychotropic medications of 41%.</p> <p>Several findings indicate that the prescribing of psychotropic medication is higher than the prevalence of mental health problems among adults with intellectual disability can explain (Folch et al., [<reflink idref="bib22" id="ref19">22</reflink>]; Lunsky et al., [<reflink idref="bib34" id="ref20">34</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref21">52</reflink>]; Song et al., [<reflink idref="bib53" id="ref22">53</reflink>]). The Norwegian study by Holden and Gitlesen ([<reflink idref="bib28" id="ref23">28</reflink>]) found that as low as half of all medication had been indicated by a psychiatric diagnosis, and most medications were prescribed without the involvement of a psychiatrist. Further, many prescriptions may be indicated by aggressive behavior (Holden & Gitlesen, [<reflink idref="bib28" id="ref24">28</reflink>]; Tyrer et al., [<reflink idref="bib61" id="ref25">61</reflink>]). Similarly, many international studies have found that psychotropic medication is prescribed to manage challenging behavior (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref26">7</reflink>]; Deb et al., [<reflink idref="bib16" id="ref27">16</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref28">52</reflink>]), often without an indication of mental health problems (Valdovinos, [<reflink idref="bib62" id="ref29">62</reflink>]). Medication is prescribed despite the lack of sufficient data to support the use of any particular medicine for such behavior (Deb et al., [<reflink idref="bib14" id="ref30">14</reflink>]; Matson & Neal, [<reflink idref="bib36" id="ref31">36</reflink>]). Sheehan et al. ([<reflink idref="bib52" id="ref32">52</reflink>]) found that 71% of people with intellectual disability that were prescribed antipsychotics had no history of severe mental health problems. While actions have been suggested to reduce the prescription of unnecessary medications (Granas et al., [<reflink idref="bib24" id="ref33">24</reflink>]), comprehensive Scandinavian studies investigating the rates of psychotropic drug use over the last two decades are lacking.</p> <p>The use of psychotropic medication in individuals with intellectual disability is influenced by various factors, including age, gender, specific diagnoses such as Down syndrome or autism spectrum disorder, and living conditions. McMahon et al. ([<reflink idref="bib38" id="ref34">38</reflink>]) identified age below 50, female gender, and absence of a mental health diagnosis as predictors of no psychotropic polypharmacy. Down syndrome has been associated with reduced use of antipsychotic medication (C. O'Dwyer et al., [<reflink idref="bib46" id="ref35">46</reflink>]), and a recent Nordic study found that individuals with intellectual disability and a co-occurring diagnosis of Down syndrome exhibit lower rates of mental health problems and challenging behavior (Flygare Wallén et al., [<reflink idref="bib21" id="ref36">21</reflink>]). Tsiouris et al. ([<reflink idref="bib59" id="ref37">59</reflink>]) found that a diagnosis of Down syndrome or cerebral palsy decrease the likelihood of certain psychotropic medication use, while autism spectrum disorder increases it. Deb et al. ([<reflink idref="bib13" id="ref38">13</reflink>]) summarized that people with autism spectrum disorder have a high prevalence of comorbid disorders (55–70%) like intellectual disability, anxiety, and psychosis as well as challenging behavior. Deb et al. ([<reflink idref="bib13" id="ref39">13</reflink>]) concluded that overmedication of people with intellectual disability and/or autism is a serious public health hazard that requires immediate attention.</p> <p>Inconsistent findings exist regarding the impact of living conditions on psychotropic medication use (García-Domínguez et al., [<reflink idref="bib23" id="ref40">23</reflink>]; Lunsky et al., [<reflink idref="bib34" id="ref41">34</reflink>]; Spreat et al., [<reflink idref="bib54" id="ref42">54</reflink>]). However, increasing age has been found to be associated with the use of psychotropic medication (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref43">7</reflink>]; García-Domínguez et al., [<reflink idref="bib23" id="ref44">23</reflink>]). People with epilepsy have a higher prevalence of mental health problems than the general population, and active epilepsy is associated with psychotropic medication. Furthermore, Bosak et al. ([<reflink idref="bib6" id="ref45">6</reflink>]) found that more than a third of their participants used other psychotropic medication in addition to their antiepileptic medication.</p> <p>Concerns have been raised about a potential overuse of psychotropic medication among people with intellectual disability, especially when used to manage challenging behavior (García-Domínguez et al., [<reflink idref="bib23" id="ref46">23</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref47">52</reflink>]). More research investigating the use of psychotropic medication by people with intellectual disability is required (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref48">7</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref49">52</reflink>]) for several reasons. Relatively few international studies have investigated the use of psychotropic medication in adults with intellectual disability. Further, many of these focus on the aging population (García-Domínguez et al., [<reflink idref="bib23" id="ref50">23</reflink>]) or factors associated with the use of antipsychotics (Koch et al., [<reflink idref="bib32" id="ref51">32</reflink>]; Lunsky et al., [<reflink idref="bib34" id="ref52">34</reflink>]; C. O'Dwyer et al., [<reflink idref="bib46" id="ref53">46</reflink>]). The unclear impact of growing international awareness of side effects and the introduction of guidelines aimed at reducing inappropriate use of psychotropic medication also warrants further investigation (Deb et al., [<reflink idref="bib11" id="ref54">11</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref55">52</reflink>]). Furthermore, D. Bowring, Totsika, Hastings, et al. ([<reflink idref="bib7" id="ref56">7</reflink>]) pointed out that the definition of challenging behavior is varying and may sometimes lack external validation in previous studies.</p> <p>The need for continued improvement in health services provided for people with intellectual disability have been targeted by the authorities in national reports (Norwegian Board of Health Supervision, [<reflink idref="bib45" id="ref57">45</reflink>]). In a recent review by Song et al. ([<reflink idref="bib53" id="ref58">53</reflink>]), no Scandinavian articles investigating the prevalence of psychotropic medication use were included. The present study used externally validated instruments to describe the occurrence of mental health problems and challenging behaviors in people with intellectual disability. The aim of the present study was to further investigate the use of psychotropic medication and to explore the association of different factors with the use of such medication in a Norwegian community-based sample of adults with all levels of intellectual disability.</p> <hd id="AN0184193810-3">METHODS</hd> <p></p> <hd id="AN0184193810-4">Design, Setting and Procedure</hd> <p>The North Health in Intellectual Disability (NOHID) study was a Norwegian cross-sectional multicenter study. All data were collected between October 2017 and December 2019. All adults registered as having a diagnosis of intellectual disability and as receiving health care services from the municipality or as having received services from the specialist health services at the University Hospital of North Norway (UNN) or St. Olav's hospital in Trondheim were eligible for participation in the study (Olsen et al., [<reflink idref="bib48" id="ref59">48</reflink>], [<reflink idref="bib49" id="ref60">49</reflink>]).</p> <p>All potential participants were provided with a detailed information sheet, along with an easy-to-read version. Each person and/or their legal representatives gave their written informed consent. Information was gathered through structured interviews and standardized instruments from participants and/or their closest relatives, carers, or support staff. Proxy informants were required to have known the participant for at least one year. The structured interviews were conducted using the POMONA-15 (P15) health indicators (Perry et al., [<reflink idref="bib50" id="ref61">50</reflink>]). The P15 is designed for ease of administration and quick completion, requiring minimal training. It consists of pre-determined questions that are asked uniformly to all participants, ensuring consistency and comparability of responses. Participants were interviewed by research assistants with professional backgrounds, including intellectual disability nurses, research nurses, and a physiotherapist. To ensure the quality of data collection, virtual meetings were regularly held with all collaborators. The instruments used in this study included the Aberrant Behavior Checklist-Community (ABC-C) and the MPAS-Check. Additionally, a separate questionnaire was administered during the structured interview to collect information about the medications used by the participants. In most cases, the instruments were filled out during the same session as the interview. However, participants were given the option to complete them at a later time if they preferred. Information concerning level of intellectual disability was confirmed by the medical records of the participants (hospital or general practitioner) (Olsen et al., [<reflink idref="bib48" id="ref62">48</reflink>], [<reflink idref="bib49" id="ref63">49</reflink>]). When interviews were conducted at the hospital, medical records were available during the session. For interviews at other locations, this information was accessed separately. The Committee for Medical Research Ethics, Health Region North (2017/811) and the Data Protection Officer at UNN and St. Olavs Hospital approved the study. The trial is registered in Clinical Trials, identification number: NCT05703503.</p> <hd id="AN0184193810-5">Participants</hd> <p>Potential participants had a verified diagnosis of intellectual disability according to the International Statistical Classification of Diseases and Related Health Problems-10 criteria (World Health Organization, [<reflink idref="bib65" id="ref64">65</reflink>]), were 16 years or older and lived in the municipalities: Trondheim, Malvik, Narvik, Balsfjord or Tromsø. There were no set criteria for exclusion; nonetheless, some people were left out when it was difficult to get accurate information or when the diagnosis of intellectual disability was withdrawn.</p> <p>The number of eligible non-participants in Malvik and Trondheim (74 participants) was unavailable. Information on eligible non-participants was only available in the municipalities of Narvik, Balsfjord, and Tromsø, which had a combined participation rate of 53% (140 participants from 266 eligible persons). The 140 participants were younger, with a mean age of 35.3 (SD 14.1), compared to the 126 eligible non-participants, with a mean age of 42.3 (SD 15.9) (<emph>p</emph> <.001). The gender distribution was similar between the two groups, with no statistically significant difference observed. The participants from the municipalities of Trondheim and Malvik had similar age and gender distribution to participants from Narvik, Balsfjord, and Tromsø, with no statistically significant differences observed (Olsen et al., [<reflink idref="bib48" id="ref65">48</reflink>], [<reflink idref="bib49" id="ref66">49</reflink>]). The 74 participants from the municipalities of Malvik and Trondheim, along with the 140 participants from the municipalities of Narvik, Balsfjord, and Tromsø, resulted in a total of 214 participants. Fifteen of these participants did not fill in the Aberrant Behavior Checklist-Community (ABC-C) and the MPAS-Check. Additionally, two participants did not provide information on the medication they used. Consequently, a total of 17 participants were excluded from the study, resulting in a final sample size of 197 participants for the analysis.</p> <p>The level of intellectual disability was categorized as mild (IQ 50–69), moderate (IQ 35–49), severe (IQ 20–34) and profound (IQ < 20) (World Health Organization, [<reflink idref="bib65" id="ref67">65</reflink>]). Severe and profound level of intellectual disability was collapsed into one category for the analysis. Participants' living conditions were categorized as (<reflink idref="bib1" id="ref68">1</reflink>) living independently or with family or (<reflink idref="bib2" id="ref69">2</reflink>) living in a group home with care (Molden et al., [<reflink idref="bib39" id="ref70">39</reflink>]).</p> <hd id="AN0184193810-6">STUDY VARIABLES</hd> <p></p> <hd id="AN0184193810-7">Age, Gender, Medication, and Diagnosis</hd> <p>The POMONA-15 (P15) health indicators (Perry et al., [<reflink idref="bib50" id="ref71">50</reflink>]) were internationally developed and field tested to assess the disparities in health that affect adults with intellectual disability. The P15 assessment battery was used to register conditions of autism spectrum disorder, Down syndrome, cerebral palsy, and epilepsy and to assess age and gender. Information about mental health problems was self-reported during the interview in response to an open question about current medical health conditions. Participants reporting sleep disorders/problems were included in the group with reported mental health problems. A separate questionnaire collected information about the medications used. The Anatomical Therapeutic Chemical (ATC) classification system recommended by the World Health Organization (WHO) was used to categorize medication based on the system or organ they interact with as well as the chemical, pharmacologic, and therapeutic characteristics of the medication.</p> <p>Psychotropics were defined as any medication that affects behavior, mood, thoughts, or perception, not including antiepileptics and analgesics. However, when a participant did not report an epilepsy diagnosis, we included mood-stabilizing antiepileptic medications in our definition of psychotropic use in line with previous research (C. O'Dwyer et al., [<reflink idref="bib46" id="ref72">46</reflink>]). Analgesics, primarily used for pain management rather than directly influencing mental health conditions, are classified under the ATC code N02, which includes subgroups such as N02A (opioids) and N02B (other analgesics and antipyretics). By excluding medications within the N02 category, we ensured that our analysis remained focused on psychotropic medications, which are relevant to the mental health conditions being studied. A binary variable was created reporting use of psychotropics (0, 1). Psychotropic medications registered included antipsychotics, anxiolytics, antidepressants, mood stabilizers, stimulants, and hypnotics.</p> <hd id="AN0184193810-8">Instruments</hd> <p>The Aberrant Behavior Checklist-Community (ABC-C) was developed to assess aberrant behavior in people with intellectual disability (Aman & Singh, [<reflink idref="bib1" id="ref73">1</reflink>]). The ABC-C contains 58 items rated on a four-point scale from (0), not a problem, to (<reflink idref="bib3" id="ref74">3</reflink>), the problem is severe. Behavior rated as a severe problem on the ABC-C corresponds to challenging behavior as defined by Emerson et al. ([<reflink idref="bib19" id="ref75">19</reflink>]). These items are summated within five subscales: Irritability, Social Withdrawal, Stereotypic Behavior, Hyperactivity/Non-compliance, and Inappropriate Speech. The internal consistency, factor structure, and convergent and divergent validity of the Norwegian version of the ABC-C have previously been considered acceptable (Halvorsen et al., [<reflink idref="bib25" id="ref76">25</reflink>]).</p> <p>The MPAS-Check is a questionnaire designed to screen for possible mental health problems among people with all levels of intellectual disability. The MPAS-Check contains 25 symptom items scored on a four-point scale from (0), has not happened, to (<reflink idref="bib3" id="ref77">3</reflink>), present in a severe form. These scores add up, in combinations described in the manual, to three subscale scores: Affective/Neurotic Disorder, Possible Organic Condition, and Psychotic Disorder. Each subscale has a stated threshold score where scores equal to, or above threshold indicates that further mental health assessment is recommended (for further information, see, Moss ([<reflink idref="bib41" id="ref78">41</reflink>]); Moss et al. ([<reflink idref="bib42" id="ref79">42</reflink>])). The internal consistency of the MPAS-Check was found to be satisfactory through independent replication of its psychometric properties. Further, the MPAS-Check was found to be sensitive to differences between diagnostic groups and had an overall sensitivity of 66% and a specificity of 70% (Sturmey et al., [<reflink idref="bib55" id="ref80">55</reflink>]).</p> <hd id="AN0184193810-9">DATA ANALYSIS</hd> <p>Statistical analysis was performed using IBM SPSS Statistics for Windows Version 29.0.1.0. In regression analysis, the default is to exclude cases with missing data on any variable. As a result, 9 participants were excluded from the final logistic regression analysis that included 188 participants. A dummy variable was created from the three levels of intellectual disability on an ordinal scale with "mild intellectual disability" as the reference category.</p> <p>The variables relationship with the use of psychotropic medication was investigated with cross tabulations for nominal variables and an independent <emph>t</emph>-test for the continuous variable of age. Comparisons were made with non-parametric statistics (Mann – Whitney <emph>U</emph>-test) for non-normally distributed scales (ABC-C subscales and MPAS-Check subscales).</p> <p>Several checks were conducted to ensure that the relevant assumptions for logistic regression analysis were met. All variance inflation factor (VIF) values for the included independent variables were below 3, which indicates that the amount of multicollinearity was low in the regression model. The enter method was applied. Including variables in the final model based exclusively on significance after univariate analyses may result in bias and escalate risk of capitalizing on incidental features of the data material (Judd & McClelland, [<reflink idref="bib31" id="ref81">31</reflink>]; Wang et al., [<reflink idref="bib63" id="ref82">63</reflink>]). The inclusion of variables in the final model was based on the research question and in accordance with relevant previous studies (García-Domínguez et al., [<reflink idref="bib23" id="ref83">23</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref84">52</reflink>]; Tsiouris et al., [<reflink idref="bib59" id="ref85">59</reflink>]).</p> <p>To investigate the relationship between the independent variables: gender (male/female), age (scale), level of intellectual disability (ordinal scale 1–3), reported mental health problems (yes/no), the three subscale scores generated by the MPAS-Check: Organic Condition (scale), Affective/Neurotic Disorder (scale), Psychotic Disorder (scale), the five subscales from the ABC-C: (I) Irritability (scale), (II) Social Withdrawal (scale), (III) Stereotypic Behavior (scale), (IV) Hyperactivity/Non-compliance (scale) and (V) Inappropriate Speech (scale), epilepsy (yes/no), Down syndrome (yes/no), autism (yes/no), cerebral palsy (yes/no), living condition (living independently or with family/living in a group home with care) and our dependent binary variable of psychotropic medication use, a multivariate logistic regression analysis was performed. Effect sizes of the independent variables are given as odds ratio (OR) with 95% confidence intervals. The significance level was set at <emph>α</emph> =.05. This study includes multiple analyses and is therefore vulnerable to obtaining false-positive results. To control for family-wise error rate the Hommel correction was applied to all results. The limit values, also known as adjustment factors, in the Hommel correction are determined by the number of hypotheses being tested. Specifically, the adjustment factor scales the p-values based on their rank, with the p-values from the multiple tests arranged in ascending order, and the total number of tests. After applying the Hommel correction, each adjusted p-value is compared to the chosen significance level (α = 0.05). The final model fit was examined using the Hosmer and Lemeshow test, and the degree of pseudo-explained variance was reported according to Nagelkerke <emph>R</emph><sups>2</sups>.</p> <hd id="AN0184193810-10">RESULTS</hd> <p></p> <hd id="AN0184193810-11">Participant Characteristics</hd> <p>A total of 197 participants [46% (<emph>n</emph> = 90) women, mean age 36.3 (SD 13.9) years] were included in the study. The participants' levels of intellectual disability were distributed as follows: mild (39%, <emph>n</emph> = 77), moderate (27%, <emph>n</emph> = 53), severe/profound (32%, <emph>n</emph> = 63), and unknown (2%, <emph>n</emph> = 4). Further, 20% (<emph>n</emph> = 39) were diagnosed with Down syndrome, 21% (<emph>n</emph> = 42) with autism, 23% (<emph>n</emph> = 45) with epilepsy, and 13% (<emph>n</emph> = 25) with cerebral palsy. Characteristics of the participants are presented in Table 1. Of the included participants, 23% (<emph>n</emph> = 45) reported experiencing mental health problems. The reported conditions included organic mental disorder, post-traumatic stress disorder, sleep disorder, schizophrenia, anxiety, depression, attention deficit hyperactivity disorder, unspecified affective disorder, and bipolar disorder. These mental health problems were reported by the informants during the interview but were not verified against the participants' medical records as part of the data collection. One or more psychotropic medications, when antiepileptics used for epilepsy and analgesics were excluded from the variable, were used by 39% (<emph>n</emph> = 76) of the participants. The proportion of participants using psychotropic medication who reported having mental health problems was 39% (<emph>n</emph> = 30). Of the 23 participants that used first and/or second-generation antipsychotic medication, 48% (<emph>n</emph> = 11) reported mental health problems, 22% (<emph>n</emph> = 5) scored at or above threshold for a psychotic disorder on the MPAS-Check and 26% (<emph>n</emph> = 6) had one or more items scored as a severe behavior problem on the ABC-C.</p> <p>Table 1. Population characteristics <emph>(N = 197).</emph></p> <p> <ephtml> <table><thead><tr><td>Characteristics</td><td>Total (<italic>N</italic> = 197)</td></tr></thead><tbody><tr><td>Age (years)</td><td /></tr><tr><td> Mean (SD)</td><td>36.3 (13.9)</td></tr><tr><td> Median (range)</td><td>33 (16–78)</td></tr><tr><td>Gender, <italic>n</italic> (%)</td><td /></tr><tr><td> Women</td><td>90 (46)</td></tr><tr><td> Men</td><td>107 (54)</td></tr><tr><td>Level of intellectual disability, <italic>n</italic> (%)</td><td /></tr><tr><td> Mild</td><td>77 (39)</td></tr><tr><td> Moderate</td><td>53 (27)</td></tr><tr><td> Severe</td><td>47 (24)</td></tr><tr><td> Profound</td><td>16 (8)</td></tr><tr><td> Unknown</td><td>4 (2)</td></tr><tr><td>Down syndrome, <italic>n</italic> (%)</td><td>39 (20)</td></tr><tr><td>Autism diagnosis, <italic>n</italic> (%)</td><td>42 (21)</td></tr><tr><td>Cerebral palsy, <italic>n</italic> (%)</td><td>25 (13)</td></tr><tr><td>Epilepsy, <italic>n</italic> (%)</td><td>45 (23)</td></tr><tr><td>Living condition, <italic>n</italic> (%)</td><td /></tr><tr><td> Group home with care</td><td>137 (70)</td></tr><tr><td> Lives with family or independently</td><td>60 (30)</td></tr><tr><td>Reported mental health problems, <italic>n</italic> (%)</td><td>45 (23)</td></tr><tr><td>Psychotropic medication, <italic>n</italic> (%)</td><td>76 (39)</td></tr><tr><td>MPAS-Check (overall prevalence), <italic>n</italic> (%)</td><td>36 (18)</td></tr><tr><td>ABC-C (overall prevalence), <italic>n</italic> (%)</td><td>32 (16)</td></tr><tr><td>Respondents, <italic>n</italic> (%)</td><td /></tr><tr><td>Self-report</td><td>4 (2)</td></tr><tr><td> Self-report and proxy</td><td>90 (46)</td></tr><tr><td> proxy</td><td>103 (52)</td></tr><tr><td> Proxy respondents, <italic>n</italic> (%)</td><td /></tr><tr><td>Family member</td><td>120 (62)</td></tr><tr><td> Healthcare professional</td><td>69 (36)</td></tr><tr><td> Other</td><td>4 (2)</td></tr></tbody></table> </ephtml> </p> <p>1 Psychotropics were defined as any medication that affects behavior, mood, thoughts, or perceptions, not including antiepileptics and analgesics.</p> <hd id="AN0184193810-12">Psychotropic Medication</hd> <p>Anxiolytics (14%, <emph>n</emph> = 28) and hypnotics/sedatives (14%, <emph>n</emph> = 28) were most commonly used, followed by antidepressants (12%, <emph>n</emph> = 23) and second-generation antipsychotics (9%, <emph>n</emph> = 18) and first-generation antipsychotics (3%, <emph>n</emph> = 6) and central nervous system stimulants (3%, <emph>n</emph> = 5). Of the participants, 61% (<emph>n</emph> = 121) used none of the included psychotropic medication categories, 27% (<emph>n</emph> = 53) used one category, 8% (<emph>n</emph> = 16) used two categories, 3% (<emph>n</emph> = 5) used three categories and 1% (<emph>n</emph> = 2) used four medication categories. The use of antiepileptics was common (24%, <emph>n</emph> = 47) and 96% (<emph>n</emph> = 45) of the users had epilepsy, while 4% (<emph>n</emph> = 2) did not have epilepsy. The two participants that used antiepileptics without having epilepsy used other categories of psychotropic medication in addition to the antiepileptics. A list of the psychotropic medications used by the study participants is provided as supplementary material (see Supplementary File 1).</p> <hd id="AN0184193810-13">ABC-C and MPAS-Check</hd> <p>The overall prevalence of mental health problems, represented by scores at or above threshold in one or more subcategories, found in the study population (<emph>n</emph> = 197) using the MPAS-Check was 18% (<emph>n</emph> = 36). The prevalence rates of the three diagnostic categories were: affective/neurotic disorder 13% (<emph>n</emph> = 25), possible organic condition 5% (<emph>n</emph> = 10) and psychotic disorder 11% (<emph>n</emph> = 22). The average score on each of the three subscales ranged from 0.39 to 1.76, with the highest score on the subscale for affective or neurotic disorder and the lowest on the subscale for psychotic disorder.</p> <p>In our sample, 16% (<emph>n</emph> = 32) had at least one item rated as a severe problem on the ABC-C, thus the prevalence of challenging behavior in our study population (<emph>n</emph> = 197) was found to be 16%. The 15 items summated within the irritability subscale were most often scored as severe problems. The five subscales had average scores ranging from 1.27 to 4.99, with the lowest average score on stereotypic behavior and highest on irritability.</p> <hd id="AN0184193810-14">Bivariate Analysis</hd> <p>Bivariate associations between participant characteristics, the MPAS-Check and the ABC-C subscales, and the binary variable of psychotropic medication use are presented in Table 2 (<emph>n</emph> = 197). Age, <emph>t</emph>(<reflink idref="bib195" id="ref86">195</reflink>) = −3.4, <emph>p</emph> = <.001, level of intellectual disability, <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib2" id="ref87">2</reflink>, _I_n_i_ = 197) = 19.4, <emph>p</emph> <.001, Down syndrome, <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib1" id="ref88">1</reflink>, _I_n_i_ = 39) = 16.5, <emph>p</emph> <.001, epilepsy, <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib1" id="ref89">1</reflink>, _I_n_i_ = 45) = 16.5, <emph>p</emph> <.001 and reported mental health problems <emph>X</emph><sups><emph>2</emph></sups> (<reflink idref="bib1" id="ref90">1</reflink>, _I_n_i_ = 45) = 19.4, <emph>p</emph> <.001 were significantly associated with psychotropic medication use after the Hommel correction was applied. Older participants, participants with severe/profound level of intellectual disability, epilepsy or reported mental health problems were more likely to use psychotropic medication. Participants with Down syndrome were less likely to use psychotropic medication. The irritability scores were significantly higher in the group using psychotropic medication (Median = 5, <emph>n</emph> = 73) compared to the group not using psychotropic medication (Median = 1, <emph>n</emph> = 121), U = 2963.5, z= −3,91, <emph>p</emph> = <.001, with a small effect size of <emph>r</emph> = 0.28 (Table 2).</p> <p>Table 2. Bivariate associations between participant characteristics, MPAS-Check and ABC-C subscales, and psychotropic medication use (<emph>N</emph> = 197).</p> <p> <ephtml> <table><thead><tr><td>Characteristics of participants</td><td>No psychotropic medication (<italic>N</italic> = 121)</td><td>One or more psychotropic medication (<italic>N</italic> = 76)</td><td>Independent t-test Chi-square test Mann-Whitney U test</td><td>Hommel correction</td></tr></thead><tbody><tr><td>Age* (years), mean (<italic>SD</italic>)</td><td>34 (12.3)</td><td>40 (15.4)</td><td><italic>t</italic>(195) = −3.4, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td> Median (range)</td><td>31 (16–65)</td><td>40.5 (17–78)</td><td /><td /></tr><tr><td>Gender, <italic>n</italic> (%)</td><td /><td /><td /><td /></tr><tr><td> Women</td><td>56 (62)</td><td>34 (38)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 0.1, <italic>p</italic> =.832</td><td>.832</td></tr><tr><td> Men</td><td>65 (61)</td><td>42 (39)</td><td /><td /></tr><tr><td>Level of intellectual disability*, <italic>n</italic> (%)</td><td /><td /><td><italic>X</italic><sup><italic>2</italic></sup>(2) = 19.4, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td> Mild</td><td>52 (68)</td><td>25 (32)</td><td /><td /></tr><tr><td> Moderate</td><td>41 (77)</td><td>12 (23)</td><td /><td /></tr><tr><td> Severe/profound</td><td>25 (40)</td><td>38 (60)</td><td /><td /></tr><tr><td>Down syndrome*, <italic>n</italic> (%)</td><td>35 (90)</td><td>4 (10)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 16.5, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td>Autism diagnosis, <italic>n</italic> (%)</td><td>24 (57)</td><td>18 (43)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 0.4, <italic>p</italic> =.521</td><td>.832</td></tr><tr><td>Cerebral palsy, <italic>n</italic> (%)</td><td>10 (40)</td><td>15 (60)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 5.5, <italic>p</italic> =.019</td><td>.128</td></tr><tr><td>Epilepsy*, <italic>n</italic> (%)</td><td>16 (36)</td><td>29 (64)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 16.5, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td>Living condition, <italic>n</italic> (%)</td><td /><td /><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 3.8, <italic>p</italic> =.051</td><td>.255</td></tr><tr><td> Group home with care</td><td>78 (57)</td><td>59 (43)</td><td /><td /></tr><tr><td> Lives with family or independently</td><td>43 (72)</td><td>17 (28)</td><td /><td /></tr><tr><td>Reported mental health problems*,<italic>n</italic> (%)</td><td>15 (33)</td><td>30 (67)</td><td><italic>X</italic><sup><italic>2</italic></sup>(1) = 19.4, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td>MPAS-Check, mean (SD)</td><td /><td /><td /><td /></tr><tr><td> Psychotic disorder</td><td>0.34 (0.80)</td><td>0.47 (0.90)</td><td><italic>z</italic> = −1.21, <italic>p</italic> =.228</td><td>.684</td></tr><tr><td> Possible organic condition</td><td>0.80 (1.55)</td><td>1.30 (2.00)</td><td><italic>z</italic> = −2.01, <italic>p</italic> =.044</td><td>.220</td></tr><tr><td> Affective or neurotic disorder</td><td>1.63 (3.54)</td><td>1.99 (3.38)</td><td><italic>z</italic> = −1.59, <italic>p</italic> =.113</td><td>.452</td></tr><tr><td>ABC-C, mean (SD)</td><td /><td /><td /><td /></tr><tr><td> Irritability*</td><td>3.74 (5.69)</td><td>7.19 (7.27)</td><td><italic>z</italic> = −3.91, <italic>p</italic> <.001</td><td>.012</td></tr><tr><td> Social withdrawal</td><td>3.03 (3.95)</td><td>3.78 (3.76)</td><td><italic>z</italic> = −1.92, <italic>p</italic> =.055</td><td>.275</td></tr><tr><td> Stereotypic behavior</td><td>1.02 (2.07)</td><td>1.67 (2.46)</td><td><italic>z</italic> = −2.38, <italic>p</italic> =.017</td><td>.119</td></tr><tr><td> Hyperactivity/noncompliance</td><td>4.25 (6.06)</td><td>5.64 (6.70)</td><td><italic>z</italic> = −2.04, <italic>p</italic> =.041</td><td>.205</td></tr><tr><td>Inappropriate speech</td><td>1.20 (1.92)</td><td>1.93 (2.43)</td><td><italic>z</italic> = −2.34, <italic>p</italic> =.020</td><td>.128</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 Psychotropics were defined as any medication that affects behavior, mood, thoughts, or perceptions, not including antiepileptics and analgesics.</item> <item>3 Abbreviations: ABC-C, The Aberrant Behavior Checklist-Community; MPAS-Check, Moss Psychiatric Assessment Schedules.</item> <item>4 *<emph>p</emph>-Values <.05 after Hommel correction.</item> </ulist> <hd id="AN0184193810-15">Multivariate Analysis</hd> <p>Factors associated with the use of psychotropic medication in multivariate logistic regression analysis are presented in Table 3. In the binary logistic regression analysis, epilepsy (OR = 3.93, 95% confidence interval (CI) 1.53, 10.12) and reported mental health problems (OR = 9.23, 95% CI 3.40, 25.03) were significant explanatory variables for psychotropic medication use after the Hommel correction was applied. Severe/profound level of intellectual disability (OR = 3.43, 95% CI 1.29, 9.12), irritability (OR = 1.14, 95% CI 1.04, 1.25), hyperactivity/noncompliance (OR = 0.89, 95% CI 0.80, 0.99) and Down syndrome (OR = 0.19, 95% CI 0.05, 0.79) were also significant explanatory variables but did not stay significant after controlling for family-wise error rate with the Hommel correction. The Hosmer and Lemeshow test indicated a good model fit (χ2 8.02, DF = 8, and <emph>p</emph> =.431). The Nagelkerke R<sups>2</sups> was 0.494.</p> <p>Table 3. Factors associated with psychotropic medication use in multivariate regression analysis (<emph>N</emph> = 188).</p> <p> <ephtml> <table><thead><tr><td>Characteristic</td><td /><td /></tr><tr><td>OR</td><td>95% CI</td><td><italic>p</italic></td><td>Hommel</td></tr></thead><tbody><tr><td>Age</td><td>1.01</td><td>0.98–1.05</td><td>.500</td><td>.99</td></tr><tr><td>Gender:</td><td /><td /><td /><td /></tr><tr><td> Women</td><td>0.95</td><td>0.41–2.19</td><td>.899</td><td>.99</td></tr><tr><td>Level of intellectual disability</td><td /><td /><td /><td /></tr><tr><td> Mild</td><td /><td /><td /><td /></tr><tr><td> Moderate</td><td>0.68</td><td>0.22–2.09</td><td>.500</td><td>.99</td></tr><tr><td> Severe/profound</td><td>3.43</td><td>1.29–9.12</td><td>.014</td><td>.20</td></tr><tr><td>MPAS-Check subcategories</td><td /><td /><td /><td /></tr><tr><td> Psychotic disorder</td><td>1.14</td><td>0.59–2.12</td><td>.699</td><td>.99</td></tr><tr><td> Possible organic condition</td><td>1.30</td><td>0.87–1.96</td><td>.204</td><td>.99</td></tr><tr><td>Affective or neurotic disorder</td><td>0.86</td><td>0.72–1.03</td><td>.104</td><td>.90</td></tr><tr><td>ABC-C subcategories</td><td /><td /><td /><td /></tr><tr><td> Irritability</td><td>1.14</td><td>1.04–1.25</td><td>.006</td><td>.10</td></tr><tr><td> Social withdrawal</td><td>0.95</td><td>0.83–1.09</td><td>.473</td><td>.99</td></tr><tr><td> Stereotypic behavior</td><td>1.00</td><td>0.77–1.30</td><td>.993</td><td>.99</td></tr><tr><td> Hyperactivity/noncompliance</td><td>0.89</td><td>0.80–0.99</td><td>.029</td><td>.38</td></tr><tr><td> Inappropriate speech</td><td>1.21</td><td>0.95–1.55</td><td>.130</td><td>.93</td></tr><tr><td>Down syndrome</td><td>0.19</td><td>0.05–0.79</td><td>.023</td><td>.30</td></tr><tr><td>Autism</td><td>0.76</td><td>0.27–2.15</td><td>.605</td><td>.99</td></tr><tr><td>Cerebral palsy</td><td>1.49</td><td>0.49–4.57</td><td>.487</td><td>.99</td></tr><tr><td>Living condition</td><td>0.78</td><td>0.28–2.21</td><td>.640</td><td>.99</td></tr><tr><td>Epilepsy*</td><td>3.93</td><td>1.53–10.12</td><td>.003</td><td>.05</td></tr><tr><td>Reported mental health problems*</td><td>9.23</td><td>3.40–25.03</td><td><.001</td><td>.019</td></tr></tbody></table> </ephtml> </p> <ulist> <item>5 Psychotropics were defined as any medication that affects behavior, mood, thoughts, or perceptions, not including antiepileptics and analgesics.</item> <item>6 Mild intellectual disability is the reference category for the participants' levels of intellectual disability.</item> <item>7 Abbreviations: <emph>p</emph>, unadjusted p-value; Hommel, p -value adjusted by the Hommel correction; CI, confidence interval; OR, odds ratio; ABC-C, The Aberrant Behavior Checklist-Community; MPAS-Check, Moss Psychiatric Assessment Schedules.</item> <item>8 *p-Values <.05 after Hommel correction.</item> </ulist> <hd id="AN0184193810-16">DISCUSSION</hd> <p>This study of a community-based sample of adults with intellectual disability has shown that reported mental health problems, increasing age, severe/profound level of intellectual disability, epilepsy, and irritability were associated with the use of psychotropic medication. Conversely, participants with Down syndrome were less likely to use psychotropic medication.</p> <p>In our sample, 39% (<emph>n</emph> = 76) used one or more psychotropic medication. This is consistent with the previous finding of 37% using psychotropic medication in a Norwegian sample living in community settings by Holden and Gitlesen ([<reflink idref="bib28" id="ref91">28</reflink>]) and the study by D. Bowring, Totsika, Hastings, et al. ([<reflink idref="bib7" id="ref92">7</reflink>]) where psychotropic medications were used by 38%. Hove et al. ([<reflink idref="bib29" id="ref93">29</reflink>]) found a 50% prevalence of drug use for the nervous system (ATC N) in adults with intellectual disability in Norway. However, this category includes not only psychotropic drugs, but also medications for pain relief (analgesics), antiepileptics, and others. Several studies have found antipsychotics to be the most common psychotropic medication used by people with intellectual disability (de Kuijper et al., [<reflink idref="bib17" id="ref94">17</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref95">52</reflink>]). Hove et al. ([<reflink idref="bib29" id="ref96">29</reflink>]) found a prevalence of 20% for the use of antipsychotics in their Norwegian sample. In the study by Holden and Gitlesen ([<reflink idref="bib28" id="ref97">28</reflink>]), first-generation antipsychotics were used by 19% of the participants and second-generation by 12%. This was not the case in our study where only 3% (<emph>n</emph> = 6) used first-generation and 9% (<emph>n</emph> = 18) used second-generation antipsychotics. A potential decline in the use of antipsychotics might be a result of a progressive shift toward reducing the use of these medications as the criticism of their alleged overuse has grown internationally (Tyrer et al., [<reflink idref="bib60" id="ref98">60</reflink>]). However, this cannot be concluded given the study design of the present study. Anxiolytics (14%, <emph>n</emph> = 28) and hypnotics/sedatives (14%, <emph>n</emph> = 28) were more frequently used by participants in our study. Sheehan et al. ([<reflink idref="bib52" id="ref99">52</reflink>]) suggested that anxiety may have been under-diagnosed in people with intellectual disability.</p> <p>The proportion of people reporting psychotropic medication use (39%, <emph>n</emph> = 76) was higher than the proportion that reported mental health problems (23%, <emph>n</emph> = 45) in the present study. This finding is in line with the results of a large UK population-based study by Sheehan et al. ([<reflink idref="bib52" id="ref100">52</reflink>]). Still, not surprisingly, the probability of using psychotropic medication was significantly higher for our participants with mental health problems.</p> <p>In our sample, 23% (<emph>n</emph> = 45) reported mental health problems and the prevalence rate found using the MPAS-Check screening instrument was 18% (<emph>n</emph> = 36). Our findings are lower than the prevalence rate (34%) of psychiatric disorders among adults with intellectual disability found in the review by Mazza et al. ([<reflink idref="bib37" id="ref101">37</reflink>]). However, prevalence was found to be lower in community-based studies (28%) than in studies of institutionalized populations, and there was a range in prevalence from 13% to 89% among the studies included in the review (Mazza et al., [<reflink idref="bib37" id="ref102">37</reflink>]). A study using clinical evaluation reported that 14% of the sample with intellectual disability had a psychiatric diagnosis according to ICD-10 criteria and that the prevalence was comparable to the general population (Deb et al., [<reflink idref="bib15" id="ref103">15</reflink>]). The characteristics correlated with intellectual disability and the symptoms of mental health problems often overlap. Therefore, identifying mental health problems in this population may be challenging (Deb et al., [<reflink idref="bib12" id="ref104">12</reflink>]) and may have affected the prevalence found in the current study. This issue is further discussed in the strengths and limitations section.</p> <p>In bivariate analyses, significant associations were found between age, level of intellectual disability, Down syndrome, epilepsy, irritability, reported mental health problems and the use of psychotropic medication (Table 2). The Norwegian study by Holden and Gitlesen ([<reflink idref="bib28" id="ref105">28</reflink>]), as well as more recent international studies, found that psychotropic medication was prescribed to manage challenging behavior (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref106">7</reflink>]; Deb et al., [<reflink idref="bib16" id="ref107">16</reflink>]; Sheehan et al., [<reflink idref="bib52" id="ref108">52</reflink>]). Irritability was the only significant subcategory of behavior in our analysis. A previous study indicated that there may be variations in prescription practices associated with different types of challenging behaviors (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref109">7</reflink>]). Challenging behavior may be misunderstood responses to stressors in the environment or adverse events from medication that are mistaken for mental health problems (Axmon et al., [<reflink idref="bib2" id="ref110">2</reflink>]; Deutsch & Burket, [<reflink idref="bib18" id="ref111">18</reflink>]; Tsiouris et al., [<reflink idref="bib59" id="ref112">59</reflink>]). People with intellectual disability frequently experience adverse reactions from conventional dosages, and side effects of medication are often misattributed to the intellectual disability itself and thus may be overshadowed (Molina-Ruiz et al., [<reflink idref="bib40" id="ref113">40</reflink>]; Reiss & Aman, [<reflink idref="bib51" id="ref114">51</reflink>]). There is evidence to suggest that cross-disciplinary teams should be involved in investigating the reasons behind challenging behaviors, developing alternatives to medication like behavioral and psychosocial plans to address the behavior, and, if medication is prescribed, organizing routine sessions for monitoring of medication to detect related problems (Deutsch & Burket, [<reflink idref="bib18" id="ref115">18</reflink>]).</p> <p>Older participants in our sample were more likely to use psychotropic medication. This has been found by several other studies (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref116">7</reflink>]; García-Domínguez et al., [<reflink idref="bib23" id="ref117">23</reflink>]). However, Hove et al. ([<reflink idref="bib29" id="ref118">29</reflink>]) found a peak at mid-adulthood in their Norwegian sample, and it may be that a similar decrease in the use of medication at old age was missed in the present study using a continuous variable of age in the analysis. Higher prevalence of e.g., epilepsy and mental health problems combined with the increasing general polypharmacy associated with age, increases the concern for adverse reactions to medication for people with intellectual disability (M. O'Dwyer et al., [<reflink idref="bib47" id="ref119">47</reflink>]). Further, psychotropic medication is used to treat challenging behavior that may be caused by emotional stress brought about by natural events and life transitions at an older age (Deutsch & Burket, [<reflink idref="bib18" id="ref120">18</reflink>]).</p> <p>The level of intellectual disability was associated with use of psychotropics and people with severe/profound intellectual disability used more. Previous research by Tsiouris et al. ([<reflink idref="bib59" id="ref121">59</reflink>]) and the Norwegian study by Holden and Gitlesen ([<reflink idref="bib28" id="ref122">28</reflink>]) did not find any significant association between severity of intellectual disability and psychotropic medication. A possible explanation is that the use of psychotropics has been found to be associated with living with residential care (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref123">7</reflink>]). Further, people living with residential care have been found to have more severe intellectual disability (Lunsky & Modi, [<reflink idref="bib35" id="ref124">35</reflink>]). However, the present study did not find an association between living condition and the use of medication and previous findings are inconsistent (García-Domínguez et al., [<reflink idref="bib23" id="ref125">23</reflink>]; Lunsky et al., [<reflink idref="bib34" id="ref126">34</reflink>]; Spreat et al., [<reflink idref="bib54" id="ref127">54</reflink>]). The level of severity of intellectual disability is associated with increased risk of challenging behavior (D. Bowring, V. Totsika, R. Hastings, et al., [<reflink idref="bib8" id="ref128">8</reflink>]). People with severe intellectual disability may have problems expressing themselves (Tassé et al., [<reflink idref="bib57" id="ref129">57</reflink>]), this may negatively affect behavior and medication may therefore more often be prescribed without a clear diagnosis (García-Domínguez et al., [<reflink idref="bib23" id="ref130">23</reflink>]).</p> <p>Participants with Down syndrome used significantly less psychotropic medication than other participants. Previously, Down syndrome has been found to be negatively associated with the use of antipsychotic medication (C. O'Dwyer et al., [<reflink idref="bib46" id="ref131">46</reflink>]) and Tsiouris et al. ([<reflink idref="bib59" id="ref132">59</reflink>]) found that Down syndrome reduced the odds of using antipsychotics and mood-stabilizers. The reason for this is unclear, but a recent Nordic study found mental health problems and challenging behavior to be less common among people with intellectual disability with a co-occurring diagnosis of Down syndrome (Flygare Wallén et al., [<reflink idref="bib21" id="ref133">21</reflink>]). Further, people with Down syndrome, compared with people with autism, have been found to be less than half as likely to have challenging behavior (Sheehan et al., [<reflink idref="bib52" id="ref134">52</reflink>]). Also, people with Down syndrome have been found to utilize healthcare resources less than the general population (Henderson et al., [<reflink idref="bib26" id="ref135">26</reflink>]) and all these factors may impact on psychotropic medication use.</p> <p>In our multivariate logistic regression analysis, epilepsy and reported mental health problems were associated with psychotropic medication use (Table 3). An association between mental health and the use of medication was expected. Worth noting is that participants that reported mental health problems had 9 times the odds of using psychotropics compared to participants that did not report such problems. Surprisingly, the present study did not find any association between mental health problems identified by the MPAS-Check screening instrument and use of psychotropic medication. Mental health problems are more frequent in people with epilepsy (Leunissen et al., [<reflink idref="bib33" id="ref136">33</reflink>]) and Bosak et al. ([<reflink idref="bib6" id="ref137">6</reflink>]) found that more than a third of their participants with epilepsy used other categories of psychotropic medication in addition to antiepileptics. Antiepileptic medication may have mood stabilizing, antidepressant, and anxiolytic properties, but may also cause agitation in the user (Ettinger, [<reflink idref="bib20" id="ref138">20</reflink>]) and thus affect behavior. Further, unpredictable medical interactions may elevate the occurrence of seizures and adverse effects. Bosak et al. ([<reflink idref="bib6" id="ref139">6</reflink>]) therefore suggested that while treating individuals with epilepsy, medical professionals from different specializations should work together more closely to reduce the risk of adverse events.</p> <p>It's worth noting that severe/profound level of intellectual disability, irritability, hyperactivity/noncompliance, and Down syndrome were significant explanatory variables in our regression analysis but did not stay significant after controlling for family-wise error rate with the Hommel correction. The multivariate logistic regression analysis accounts for more factors that influence the use of medication than the bivariate analyses, and this affects significance. The Hommel correction is considered more powerful than the commonly used Bonferroni correction and therefore less likely to throw away true positives. Still, it is argued that when adjusting for multiple comparisons significant or noteworthy findings may be overlooked that would alternatively be considered significant (Barnett et al., [<reflink idref="bib4" id="ref140">4</reflink>]).</p> <hd id="AN0184193810-17">Strengths and Limitations</hd> <p>In this study, the number of eligible non-participants in the municipalities of Malvik and Trondheim (74 participants) was unavailable. Consequently, it is not possible to determine the representativeness of the final sample, which may affect the generalizability of the results. Another limitation of the study is selection bias. Mental health problems may create barriers to research participation. Also, selecting our eligible participants based on whether they received care or health services may have impacted our sample's demographic representation. Furthermore, representativity analysis revealed that the participants included from Narvik, Balsfjord, and Tromsø were significantly younger than the eligible nonparticipants. Selection bias may have affected the prevalence of challenging behaviors, mental health problems and medication use. However, the results from our screening instruments regarding challenging behavior and mental health problems were in line with those reported by Taylor et al. ([<reflink idref="bib58" id="ref141">58</reflink>]) and Myrbakk and Von Tetzchner ([<reflink idref="bib44" id="ref142">44</reflink>]). The prevalence of psychotropic medication use found in our study was also comparable to previous studies (D. Bowring, Totsika, Hastings, et al., [<reflink idref="bib7" id="ref143">7</reflink>]; Holden & Gitlesen, [<reflink idref="bib28" id="ref144">28</reflink>]). Applying diagnostic criteria and instruments designed for the general population to people with intellectual disability can often be problematic (Deb et al., [<reflink idref="bib12" id="ref145">12</reflink>]). As a result, diagnostic instruments, like the MPAS-Check utilized in the current study, have been designed. While this instrument is a valuable tool, it is important to acknowledge that it only captures a limited range of symptoms and disorders compressed into three diagnostic categories. Furthermore, a notable limitation of the MPAS-Check is its focus on current symptoms, which may not capture historical mental health issues managed with long-term medication. This may have led to underreporting past mental health problems in the present study, especially relevant if participants no longer cross the threshold of the MPAS-Check due to the protective effects of sustained medication use. The screening instrument should not be the only method used for identifying psychiatric disorders in people with intellectual disability according to Sturmey et al. ([<reflink idref="bib55" id="ref146">55</reflink>]). In the current study, 10 participants had an overlap between reported mental health problems (<emph>n</emph> = 45) and mental health problems identified by the MPAS-Check (<emph>n</emph> = 36). Therefore, both the MPAS-Check and reported mental health problems were included and analyzed separately in the current study.</p> <p>A limitation of our study and area for improvement is the lack of confirmed indications in the form of a medical diagnosis for the use of psychotropic medication in our data material. This may have led to classification problems when a medication had multiple purposes. Further, the lack of confirmed diagnosis of mental health problems in our study may be a limitation when reporting current mental health problems. However, this may have reduced the risk of episodes experienced several years back, not necessarily relevant today, being reported as a current mental health problem. This study employed a continuous variable of age in the analysis instead of a categorical variable with age groups. This reduces loss of power and the risk of bias but may be a limitation if the relationship between age and the use of psychotropic medication is not linear.</p> <p>One of the study's strengths was the capacity to obtain data on participants' intellectual disability levels from their medical records. The decision to collapse severe and profound level of intellectual disability into one category for analysis was deemed necessary because of small sample sizes in the original categories and the implications this would have for the analysis. This practice is in line with previous relevant studies (García-Domínguez et al., [<reflink idref="bib23" id="ref147">23</reflink>]; Olsen et al., [<reflink idref="bib48" id="ref148">48</reflink>]).</p> <hd id="AN0184193810-18">CONCLUSION</hd> <p>In this cross-sectional study of adults with intellectual disability in Norway, the proportion of people who reported psychotropic medication use was higher than the proportion that reported mental health problems, and the prevalence of mental health problems indicated by the MPAS-Check. Although being beyond what can be concluded in the present study, our results may indicate a potential underdiagnosis of psychiatric disorders among people with intellectual disability that should be further investigated. Further, our participants used less antipsychotics than previously reported, and this could indicate a shift away from the criticized practice of prescribing antipsychotic medication to manage challenging behavior. Epilepsy was found to be associated with psychotropic medication use. Polypharmacy for this group, already using antiepileptic medication, may increase the occurrence of seizures and risk of adverse events and should be monitored carefully. The higher prevalence of comorbidities and challenging behavior among people with intellectual disability makes them more prone to polypharmacy compared to the general population. People with intellectual disability are also at greater risk of being prescribed unspecific and potentially inappropriate medication. Long-term use of antipsychotics can cause tardive dyskinesia, and the sedative effect of psychotropic medication can have a negative effect on attention, language and learning. Therefore, it is important to routinely monitor prescriptions to assess the adherence of the user, the benefits of the medication and to keep an eye on side effects and medication interactions.</p> <hd id="AN0184193810-19">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0184193810-20">Ethical Approvals and Consent to Participate</hd> <p>The Committee for Medical Research Ethics, Health Region Central (2022/493747) and the Data Protection Officer at UNN and St. Olavs Hospital approved the study. The trial is registered in Clinical Trials, identification number: NCT05703503. Each person and/or their legal representatives gave their written informed consent.</p> <hd id="AN0184193810-21">Data Availability Statement</hd> <p>The data that support the findings of this study are available on request from the corresponding author, (ERP). The data are not publicly available due to restrictions (containing information that could compromise the privacy of research participants).</p> <hd id="AN0184193810-22">SUPPLEMENTARY MATERIAL</hd> <p>Supplemental data for this article can be accessed online at https://doi.org/10.1080/19315864.2024.2447232.</p> <ref id="AN0184193810-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref68" type="bt">1</bibl> <bibtext> Aman, M. G., & Singh, N. (2017). Aberrant behavior checklist manual (2nd ed.). Slosson Educational Publications.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref69" type="bt">2</bibl> <bibtext> Axmon, A., Ahlström, G., Gagnemo Persson, R., & Eberhard, J. (2019). Demographic and diagnostic profiles of older people with intellectual disability and prescription of antipsychotics. Social Psychiatry & Psychiatric Epidemiology, 54 (8), 937 – 944. https://doi.org/10.1007/s00127-019-01695-w</bibtext> </blist> <blist> <bibl id="bib3" idref="ref13" type="bt">3</bibl> <bibtext> Axmon, A., Sandberg, M., Ahlström, G., & Midlöv, P. (2017). Prescription of potentially inappropriate medications among older people with intellectual disability: A register study. BMC Pharmacology & Toxicology, 18 (1), 1 – 10. https://doi.org/10.1186/s40360-017-0174-1</bibtext> </blist> <blist> <bibl id="bib4" idref="ref140" type="bt">4</bibl> <bibtext> Barnett, M. J., Doroudgar, S., Khosraviani, V., & Ip, E. J. (2022). Multiple comparisons: To compare or not to compare, that is the question. Research in Social & Administrative Pharmacy, 18 (2), 2331 – 2334. https://doi.org/10.1016/j.sapharm.2021.07.006</bibtext> </blist> <blist> <bibl id="bib5" idref="ref10" type="bt">5</bibl> <bibtext> Bertelli, M. O., Rossi, M., Scuticchio, D., & Bianco, A. (2015). Diagnosing psychiatric disorders in people with intellectual disabilities: Issues and achievements. Advances in Mental Health and Intellectual Disabilities, 9 (5), 230 – 242. https://doi.org/10.1108/AMHID-05-2015-0023</bibtext> </blist> <blist> <bibl id="bib6" idref="ref45" type="bt">6</bibl> <bibtext> Bosak, M., Cyranka, K., Dudek, D., Kowalik, M., Mołek, P., & Słowik, A. (2018). Psychiatric comedication in patients with epilepsy. Epilepsy & Behavior, 83, 207 – 211. https://doi.org/10.1016/j.yebeh.2018.03.033</bibtext> </blist> <blist> <bibl id="bib7" idref="ref26" type="bt">7</bibl> <bibtext> Bowring, D., Totsika, V., Hastings, R. P., Toogood, S., & McMahon, M. (2017). Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study. Journal of Intellectual Disability Research, 61 (6), 604 – 617. https://doi.org/10.1111/jir.12359</bibtext> </blist> <blist> <bibl id="bib8" idref="ref128" type="bt">8</bibl> <bibtext> Bowring, D., Totsika, V., Hastings, R., Toogood, S., & Griffith, G. (2017). Challenging behaviours in adults with an intellectual disability: A total population study and exploration of risk indices. British Journal of Clinical Psychology, 56 (1), 16 – 32. https://doi.org/10.1111/bjc.12118</bibtext> </blist> <blist> <bibl id="bib9" idref="ref5" type="bt">9</bibl> <bibtext> Buckles, J., Luckasson, R., & Keefe, E. (2013). A systematic review of the prevalence of psychiatric disorders in adults with intellectual disability, 2003-2010. Journal of Mental Health Research in Intellectual Disabilities, 6 (3), 181 – 207. https://doi.org/10.1080/19315864.2011.651682</bibtext> </blist> <blist> <bibtext> Cooper, S.-A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: Prevalence and associated factors. British Journal of Psychiatry, 190 (1), 27 – 35. https://doi.org/10.1192/bjp.bp.106.022483</bibtext> </blist> <blist> <bibtext> Deb, S., Kwok, H., Bertelli, M., Salvador-Carulla, L., Bradley, E., Torr, J., & Barnhill, J. (2009). International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry, 8 (3), 181 – 186. https://doi.org/10.1002/j.2051-5545.2009.tb00248.x</bibtext> </blist> <blist> <bibtext> Deb, S., Perera, B., Krysta, K., Ozer, M., Bertelli, M., Novell, R., Wieland, J., & Sappok, T. (2022). The European guideline on the assessment and diagnosis of psychiatric disorders in adults with intellectual disabilities. The European Journal of Psychiatry, 36 (1), 11 – 25. https://doi.org/10.1016/j.ejpsy.2021.10.002</bibtext> </blist> <blist> <bibtext> Deb, S., Roy, M., & Limbu, B. (2023). Pharmacological management of psychopathology in people with intellectual disabilities and/or autism spectrum disorder. BJPsych Advances, 29 (5), 322 – 333. https://doi.org/10.1192/bja.2022.61</bibtext> </blist> <blist> <bibtext> Deb, S., Sohanpal, S., Soni, R., Lentre, L., & Unwin, G. (2007). The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities. Journal of Intellectual Disability Research, 51 (10), 766 – 777. https://doi.org/10.1111/j.1365-2788.2007.00950.x</bibtext> </blist> <blist> <bibtext> Deb, S., Thomas, M., & Bright, C. (2001). Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. Journal of Intellectual Disability Research, 45 (6), 495 – 505. https://doi.org/10.1046/j.1365-2788.2001.00374.x</bibtext> </blist> <blist> <bibtext> Deb, S., Unwin, G., & Deb, T. (2015). Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. Journal of Intellectual Disability Research, 59 (1), 11 – 25. https://doi.org/10.1111/jir.12119</bibtext> </blist> <blist> <bibtext> de Kuijper, G., Hoekstra, P., Visser, F., Scholte, F. A., Penning, C., & Evenhuis, H. (2010). Use of antipsychotic drugs in individuals with intellectual disability (ID) in the Netherlands: Prevalence and reasons for prescription. Journal of Intellectual Disability Research, 54 (7), 659 – 667. https://doi.org/10.1111/j.1365-2788.2010.01275.x</bibtext> </blist> <blist> <bibtext> Deutsch, S. I., & Burket, J. A. (2021). Psychotropic medication use for adults and older adults with intellectual disability; selective review, recommendations and future directions. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 104, 110017. https://doi.org/10.1016/j.pnpbp.2020.110017</bibtext> </blist> <blist> <bibtext> Emerson, E., Kiernan, C., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., Mason, L., & Hatton, C. (2001). The prevalence of challenging behaviors: A total population study. Research in Developmental Disabilities, 22 (1), 77 – 93. https://doi.org/10.1016/S0891-4222(00)00061-5</bibtext> </blist> <blist> <bibtext> Ettinger A B. (2006). Psychotropic effects of antiepileptic drugs. Neurology, 67 (11), 1916 – 1925. 10.1212/01.wnl.0000247045.85646.c0</bibtext> </blist> <blist> <bibtext> Flygare Wallén, E., Ljunggren, G., Wahlström, L., Pettersson, D., Carlsson, A. C., & Wändell, P. (2023). The prevalence of self-harm and mental disorders among individuals with intellectual disabilities. Nordic Journal of Psychiatry, 77 (7), 712 – 720. https://doi.org/10.1080/08039488.2023.2228292</bibtext> </blist> <blist> <bibtext> Folch, A., Salvador-Carulla, L., Vicens, P., Cortés, M. J., Irazábal, M., Muñoz, S., Rovira, L., Orejuela, C., González, J. A., & Martínez-Leal, R. (2019). Health indicators in intellectual developmental disorders: The key findings of the POMONA-ESP project. Journal of Applied Research in Intellectual Disabilities, 32 (1), 23 – 34. https://doi.org/10.1111/jar.12498</bibtext> </blist> <blist> <bibtext> García-Domínguez, L., Navas, P., Verdugo, M. Á., Arias, V. B., & Gómez, L. E. (2022). Psychotropic drugs intake in people aging with intellectual disability: Prevalence and predictors. Journal of Applied Research in Intellectual Disabilities, 35 (5), 1109 – 1118. https://doi.org/10.1111/jar.12996</bibtext> </blist> <blist> <bibtext> Granas, A. G., Halvorsen, K. H., Wendelbo, J., & Johannessen Landmark, C. (2019). Interdisciplinary medication review to improve pharmacotherapy for patients with intellectual disabilities. International Journal of Clinical Pharmacy, 41 (6), 1516 – 1525. https://doi.org/10.1007/s11096-019-00914-3</bibtext> </blist> <blist> <bibtext> Halvorsen, M., Aman, M. G., Mathiassen, B., Brøndbo, P. H., Steinsvik, O. O., & Martinussen, M. (2019). Psychometric properties of the Norwegian aberrant behavior checklist and diagnostic relationships in a neuro-pediatric sample. Journal of Mental Health Research in Intellectual Disabilities, 12 (3–4), 234 – 255. https://doi.org/10.1080/19315864.2019.1630872</bibtext> </blist> <blist> <bibtext> Henderson, A., Lynch, S. A., Wilkinson, S., & Hunter, M. (2007). Adults with Down's syndrome: The prevalence of complications and health care in the community. British Journal of General Practice, 57 (534), 50 – 55.</bibtext> </blist> <blist> <bibtext> Holden, B., & Gitlesen, J. P. (2003). Prevalence of psychiatric symptoms in adults with mental retardation and challenging behaviour. Research in Developmental Disabilities, 24 (5), 323 – 332. https://doi.org/10.1016/S0891-4222(03)00060-X</bibtext> </blist> <blist> <bibtext> Holden, B., & Gitlesen, J. P. (2004). Psychotropic medication in adults with mental retardation: Prevalence, and prescription practices. Research in Developmental Disabilities, 25 (6), 509 – 521. https://doi.org/10.1016/j.ridd.2004.03.004</bibtext> </blist> <blist> <bibtext> Hove, O., Biringer, E., Havik, O. E., Assmus, J., Braatveit, K. J., Holm, S. E. H., & Hermann, M. (2019). Prevalence of drug use among adults with intellectual disabilities compared with drug use in the general population. Pharmacoepidemiology and Drug Safety, 28 (3), 337 – 344. https://doi.org/10.1002/pds.4741</bibtext> </blist> <blist> <bibtext> Hughes McCormack, L. A., Rydzewska, E., Henderson, A., MacIntyre, C., Rintoul, J., & Cooper, S.-A. (2017). Prevalence of mental health conditions and relationship with general health in a whole-country population of people with intellectual disabilities compared with the general population. British Journal of Psychiatry Open, 3 (5), 243 – 248. https://doi.org/10.1192/bjpo.bp.117.005462</bibtext> </blist> <blist> <bibtext> Judd, C. M., & McClelland, G. H. (1989). Data analysis: A model-comparison approach. Harcourt Brace Jovanovich. https://books.google.no/books?id=MaEZAQAAIAAJ</bibtext> </blist> <blist> <bibtext> Koch, A. D., Dobrindt, J., & Schützwohl, M. (2021). Prevalence of psychotropic medication and factors associated with antipsychotic treatment in adults with intellectual disabilities: A cross-sectional, epidemiological study in Germany. Journal of Intellectual Disability Research, 65 (2), 186 – 198. https://doi.org/10.1111/jir.12802</bibtext> </blist> <blist> <bibtext> Leunissen, C. L. F., de la Parra, N. M., Tan, I. Y., Rentmeester, T. W., Vader, C. I., Veendrick-Meekes, M. J. B. M., & Aldenkamp, A. P. (2011). Antiepileptic drugs with mood stabilizing properties and their relation with psychotropic drug use in institutionalized epilepsy patients with intellectual disability. Research in Developmental Disabilities, 32 (6), 2660 – 2668. https://doi.org/10.1016/j.ridd.2011.06.007</bibtext> </blist> <blist> <bibtext> Lunsky, Y., Khuu, W., Tadrous, M., Vigod, S., Cobigo, V., & Gomes, T. (2018). Antipsychotic use with and without comorbid psychiatric diagnosis among adults with intellectual and developmental disabilities. The Canadian Journal of Psychiatry, 63 (6), 361 – 369. https://doi.org/10.1177/0706743717727240</bibtext> </blist> <blist> <bibtext> Lunsky, Y., & Modi, M. (2018). Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatric Services, 69 (2), 242 – 246. https://doi.org/10.1176/appi.ps.201700032</bibtext> </blist> <blist> <bibtext> Matson, J. L., & Neal, D. (2009). Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: An overview. Research in Developmental Disabilities, 30 (3), 572 – 586. https://doi.org/10.1016/j.ridd.2008.08.007</bibtext> </blist> <blist> <bibtext> Mazza, M. G., Rossetti, A., Crespi, G., & Clerici, M. (2020). Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta-analysis. Journal of Applied Research in Intellectual Disabilities, 33 (2), 126 – 138. https://doi.org/10.1111/jar.12654</bibtext> </blist> <blist> <bibtext> McMahon, M., Hatton, C., & Bowring, D. (2020). Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: A cross-sectional total population study. Journal of Intellectual Disability Research, 64 (11), 834 – 851. https://doi.org/10.1111/jir.12775</bibtext> </blist> <blist> <bibtext> Molden, T. H., Wendelborg, C., & Tøssebro, J. (2009). Levekår blant personer med nedsatt funksjonsevne. Analyse av levekårsundersøkelsen blant personer med nedsatt funksjonsevne 2007. NTNU samfunnsforskning.</bibtext> </blist> <blist> <bibtext> Molina-Ruiz, R. M., Martín-Carballeda, J., Asensio-Moreno, I., & Montañés-Rada, F. (2017). A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry. International Journal of Psychiatry in Medicine, 52 (2), 176 – 189. https://doi.org/10.1177/0091217417720896</bibtext> </blist> <blist> <bibtext> Moss, S. (2012). The PAS-ADD assessments and their continuing conceptual development. Advances in Mental Health and Intellectual Disabilities, 6 (1), 5 – 16. https://doi.org/10.1108/20441281211198817</bibtext> </blist> <blist> <bibtext> Moss, S., Prosser, H., Costello, H., Simpson, N., Patel, P., Rowe, S., Turner, S., & Hatton, C. (1998). Reliability and validity of the PAS-ADD checklist for detecting psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42 (2), 173 – 183. https://doi.org/10.1046/j.1365-2788.1998.00116.x</bibtext> </blist> <blist> <bibtext> Müller, K., Helmes, A., Kleischmann, A., & Bengel, J. (2022). Assessing psychiatric symptomatology in adults with intellectual disabilities: Psychometric properties of German versions of the PAS-ADD checklist and the mini PAS-ADD. Journal of Mental Health Research in Intellectual Disabilities, 15 (2), 111 – 129. https://doi.org/10.1080/19315864.2022.2029645</bibtext> </blist> <blist> <bibtext> Myrbakk, E., & Von Tetzchner, S. (2008). The prevalence of behavior problems among people with intellectual disability living in community settings. Journal of Mental Health Research in Intellectual Disabilities, 1 (3), 205 – 222. https://doi.org/10.1080/19315860802115607</bibtext> </blist> <blist> <bibtext> Norwegian Board of Health Supervision. (2017). It is all about life. Summary of countrywide supervision in 2016 of municipal health and social services for people with mental disabilities. https://<ulink href="http://www.helsetilsynet.no/publikasjoner/rapport-fra-helsetilsynet/2017/det-gjelder-livet-oppsummering-av-landsomfattende-tilsyn-i-2016-med-kommunale-helse-og-omsorgstjenester-til-personer-med-utviklingshemming/">www.helsetilsynet.no/publikasjoner/rapport-fra-helsetilsynet/2017/det-gjelder-livet-oppsummering-av-landsomfattende-tilsyn-i-2016-med-kommunale-helse-og-omsorgstjenester-til-personer-med-utviklingshemming/</ulink></bibtext> </blist> <blist> <bibtext> O'Dwyer, C., McCallion, P., Henman, M., McCarron, M., O'Leary, E., Burke, E., O'Connell, J., & O'Dwyer, M. (2019). Prevalence and patterns of antipsychotic use and their associations with mental health and problem behaviours among older adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 32 (4), 981 – 993. https://doi.org/10.1111/jar.12591</bibtext> </blist> <blist> <bibtext> O'Dwyer, M., McCallion, P., McCarron, M., & Henman, M. (2018). Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: A neglected area of research. Therapeutic Advances in Drug Safety, 9 (9), 535 – 557. https://doi.org/10.1177/2042098618782785</bibtext> </blist> <blist> <bibtext> Olsen, M. I., Halvorsen, M. B., Søndenaa, E., Langballe, E. M., Bautz-Holter, E., Stensland, E., Tessem, S., & Anke, A. (2021). How do multimorbidity and lifestyle factors impact the perceived health of adults with intellectual disabilities? Journal of Intellectual Disability Research, 65 (8), 772 – 783. https://doi.org/10.1111/jir.12845</bibtext> </blist> <blist> <bibtext> Olsen, M. I., Søndenaa, E., Langballe, E. M., Halvorsen, M. B., Wilhelmsen, P., Bautz-Holter, E., & Anke, A. (2022). Use of health and dental care services in adults with intellectual disability in relation to age and intellectual disability levels. Journal of Intellectual & Developmental Disability, 48 (2), 172 – 183. https://doi.org/10.3109/13668250.2022.2109823</bibtext> </blist> <blist> <bibtext> Perry, J., Linehan, C., Kerr, M., Salvador-Carulla, L., Zeilinger, E., Weber, G., Walsh, P., Van Schrojenstein Lantman de Valk, H., Haveman, M., Azema, B., Buono, S., Câra, A. C., Germanavicius, A., Van Hove, G., Määttä, T., Berger, D. M., & Tossebro, J. (2010). The P15 - a multinational assessment battery for collecting data on health indicators relevant to adults with intellectual disabilities. Journal of Intellectual Disability Research, 54 (11), 981 – 991. https://doi.org/10.1111/j.1365-2788.2010.01322.x</bibtext> </blist> <blist> <bibtext> Reiss, S., & Aman, M. G. (1997). The international consensus process on psychopharmacology and intellectual disability. Journal of Intellectual Disability Research, 41 (6), 448 – 455. https://doi.org/10.1111/j.1365-2788.1997.tb00736.x</bibtext> </blist> <blist> <bibtext> Sheehan, R., Hassiotis, A., Walters, K., Osborn, D., Strydom, A., & Horsfall, L. (2015). Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ: British Medical Journal, 351, h4326. https://doi.org/10.1136/bmj.h4326</bibtext> </blist> <blist> <bibtext> Song, M., Rubin, B. S., Ha, J. W., Ware, R. S., Doan, T. N., & Harley, D. (2023). Use of psychotropic medications in adults with intellectual disability: A systematic review and meta-analysis. The Australian and New Zealand Journal of Psychiatry, 57 (5), 661 – 674. https://doi.org/10.1177/00048674221149864</bibtext> </blist> <blist> <bibtext> Spreat, S., Conroy, J. W., & Fullerton, A. (2004). Statewide longitudinal survey of psychotropic medication use for persons with mental retardation: 1994 to 2000. American Journal on Mental Retardation, 109 (4), 322 – 331. https://doi.org/10.1352/0895-8017(2004)109<322:SLSOPM>2.0.CO;2</bibtext> </blist> <blist> <bibtext> Sturmey, P., Newton, J. T., Cowley, A., Bouras, N., & Holt, G. (2005). The PAS-ADD checklist: Independent replication of its psychometric properties in a community sample. British Journal of Psychiatry, 186 (4), 319 – 323. https://doi.org/10.1192/bjp.186.4.319</bibtext> </blist> <blist> <bibtext> Tan, X., Marshall, V. D., Balkrishnan, R., Patel, I., Chang, J., & Erickson, S. R. (2015). Psychotropic medication adherence among community-based individuals with developmental disabilities and mental illness. Journal of Mental Health Research in Intellectual Disabilities, 8 (1), 1 – 22. https://doi.org/10.1080/19315864.2014.959216</bibtext> </blist> <blist> <bibtext> Tassé, M., Bertelli, M., Kates, W., Simon, E., & Navas, P. (2017). Intellectual disability (intellectual disability disorder). Diagnostic Manual-Intellectual Disability, 2, 75 – 90.</bibtext> </blist> <blist> <bibtext> Taylor, J. L., Hatton, C., Dixon, L., & Douglas, C. (2004). Screening for psychiatric symptoms: PAS-ADD checklist norms for adults with intellectual disabilities. Journal of Intellectual Disability Research, 48 (1), 37 – 41. https://doi.org/10.1111/j.1365-2788.2004.00585.x</bibtext> </blist> <blist> <bibtext> Tsiouris, J. A., Kim, S.-Y., Brown, W. T., Pettinger, J., & Cohen, I. L. (2013). Prevalence of psychotropic drug use in adults with intellectual disability: Positive and negative findings from a large scale study. Journal of Autism & Developmental Disorders, 43 (3), 719 – 731. https://doi.org/10.1007/s10803-012-1617-6</bibtext> </blist> <blist> <bibtext> Tyrer, P., Cooper, S.-A., & Hassiotis, A. (2014). Drug treatments in people with intellectual disability and challenging behaviour. British Medical Journal Publishing Group, 349 (jul04 1), g4323 – g4323. https://doi.org/10.1136/bmj.g4323</bibtext> </blist> <blist> <bibtext> Tyrer, P., Oliver-Africano, P., Romeo, R., Knapp, M., Dickens, S., Bouras, N., Ahmed, Z., Cooray, S., Deb, S., Murphy, D., Hare, M., Meade, M., Reece, B., Kramo, K., Bhaumik, S., Harley, D., Regan, A., Thomas, D. ... Eliahoo, J. (2009). Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: A randomised controlled trial (NACHBID). Health Technology Assessment, 13 (21), i – 73. https://doi.org/10.3310/hta13210</bibtext> </blist> <blist> <bibtext> Valdovinos, M. G. (2019). Psychotropic medication in intellectual and developmental disabilities: Patterns of use and recommendations for monitoring effects. Current Developmental Disorders Reports, 6 (4), 195 – 201. https://doi.org/10.1007/s40474-019-00179-5</bibtext> </blist> <blist> <bibtext> Wang, H., Peng, J., Wang, B., Lu, X., Zheng, J. Z., Wang, K., Tu, X. M., & Feng, C. (2017). Inconsistency between univariate and multiple logistic regressions. Shanghai Archives of Psychiatry, 29 (2), 124 – 128. https://doi.org/10.11919/j.issn.1002-0829.217031</bibtext> </blist> <blist> <bibtext> Whitaker, S., & Read, S. (2006). The prevalence of psychiatric disorders among people with intellectual disabilities: An analysis of the literature. Journal of Applied Research in Intellectual Disabilities, 19 (4), 330 – 345. https://doi.org/10.1111/j.1468-3148.2006.00293.x</bibtext> </blist> <blist> <bibtext> World Health Organization. (2019). International statistical classification of diseases and related health problems (10th ed.). https://icd.who.int/browse10/2019/en</bibtext> </blist> </ref> <aug> <p>By Erlend Refseth Pedersen; Audny Anke; Silje Marie Tessem; Monica Isabel Olsen and Erik Søndenaa</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib30" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib27" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib64" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib58" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib43" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib37" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib56" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib28" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib29" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib52" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib53" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib22" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib34" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib61" firstref="ref25"></nolink> <nolink nlid="nl16" bibid="bib16" firstref="ref27"></nolink> <nolink nlid="nl17" bibid="bib62" firstref="ref29"></nolink> <nolink nlid="nl18" bibid="bib14" firstref="ref30"></nolink> <nolink nlid="nl19" bibid="bib36" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib24" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib38" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib46" firstref="ref35"></nolink> <nolink nlid="nl23" bibid="bib21" firstref="ref36"></nolink> <nolink nlid="nl24" bibid="bib59" firstref="ref37"></nolink> <nolink nlid="nl25" bibid="bib13" firstref="ref38"></nolink> <nolink nlid="nl26" bibid="bib23" firstref="ref40"></nolink> <nolink nlid="nl27" bibid="bib54" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib32" firstref="ref51"></nolink> <nolink nlid="nl29" bibid="bib11" firstref="ref54"></nolink> <nolink nlid="nl30" bibid="bib45" firstref="ref57"></nolink> <nolink nlid="nl31" bibid="bib48" firstref="ref59"></nolink> <nolink nlid="nl32" bibid="bib49" firstref="ref60"></nolink> <nolink nlid="nl33" bibid="bib50" firstref="ref61"></nolink> <nolink nlid="nl34" bibid="bib65" firstref="ref64"></nolink> <nolink nlid="nl35" bibid="bib39" firstref="ref70"></nolink> <nolink nlid="nl36" bibid="bib19" firstref="ref75"></nolink> <nolink nlid="nl37" bibid="bib25" firstref="ref76"></nolink> <nolink nlid="nl38" bibid="bib41" firstref="ref78"></nolink> <nolink nlid="nl39" bibid="bib42" firstref="ref79"></nolink> <nolink nlid="nl40" bibid="bib55" firstref="ref80"></nolink> <nolink nlid="nl41" bibid="bib31" firstref="ref81"></nolink> <nolink nlid="nl42" bibid="bib63" firstref="ref82"></nolink> <nolink nlid="nl43" bibid="bib195" firstref="ref86"></nolink> <nolink nlid="nl44" bibid="bib17" firstref="ref94"></nolink> <nolink nlid="nl45" bibid="bib60" firstref="ref98"></nolink> <nolink nlid="nl46" bibid="bib15" firstref="ref103"></nolink> <nolink nlid="nl47" bibid="bib12" firstref="ref104"></nolink> <nolink nlid="nl48" bibid="bib18" firstref="ref111"></nolink> <nolink nlid="nl49" bibid="bib40" firstref="ref113"></nolink> <nolink nlid="nl50" bibid="bib51" firstref="ref114"></nolink> <nolink nlid="nl51" bibid="bib47" firstref="ref119"></nolink> <nolink nlid="nl52" bibid="bib35" firstref="ref124"></nolink> <nolink nlid="nl53" bibid="bib57" firstref="ref129"></nolink> <nolink nlid="nl54" bibid="bib26" firstref="ref135"></nolink> <nolink nlid="nl55" bibid="bib33" firstref="ref136"></nolink> <nolink nlid="nl56" bibid="bib20" firstref="ref138"></nolink> <nolink nlid="nl57" bibid="bib44" firstref="ref142"></nolink>
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  Label: Title
  Group: Ti
  Data: Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Erlend+Refseth+Pedersen%22">Erlend Refseth Pedersen</searchLink><br /><searchLink fieldCode="AR" term="%22Audny+Anke%22">Audny Anke</searchLink><br /><searchLink fieldCode="AR" term="%22Silje+Marie+Tessem%22">Silje Marie Tessem</searchLink><br /><searchLink fieldCode="AR" term="%22Monica+Isabel+Olsen%22">Monica Isabel Olsen</searchLink><br /><searchLink fieldCode="AR" term="%22Erik+Søndenaa%22">Erik Søndenaa</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Mental+Health+Research+in+Intellectual+Disabilities%22"><i>Journal of Mental Health Research in Intellectual Disabilities</i></searchLink>. 2025 18(2):181-203.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 23
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Drug+Therapy%22">Drug Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Check+Lists%22">Check Lists</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Epilepsy%22">Epilepsy</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Norway%22">Norway</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Aberrant+Behavior+Checklist%22">Aberrant Behavior Checklist</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/19315864.2024.2447232
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1931-5864<br />1931-5872
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Concerns arise about overuse of psychotropic medication among people with intellectual disability. This study investigates occurrence of mental health problems, psychotropic medication use, and factors associated with the use of psychotropics in a Norwegian community-based sample. Method: A cross-sectional community-based survey including 197 adults with intellectual disability. The POMONA-15 health indicators, the Aberrant Behavior Checklist-Community and the MPAS-Check were used for the assessment of factors associated with psychotropic medication use. Results: A total of 39% (n = 76) used psychotropic medication, 18% (n = 36) scored above cut-off on mental health screening and 23% (n = 45) reported mental health problems. Use of psychotropic medication was associated with older age, more severe intellectual disability, epilepsy, irritability and reported mental health problems. Conclusion: Psychotropic medication is still widely used, but antipsychotic drugs were used less frequently than previously reported. The use of psychotropics should be carefully evaluated, especially for populations with increased risk of adverse events.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1498339
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1498339
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/19315864.2024.2447232
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 23
        StartPage: 181
    Subjects:
      – SubjectFull: Drug Therapy
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Check Lists
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Individual Characteristics
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Severity (of Disability)
        Type: general
      – SubjectFull: Epilepsy
        Type: general
      – SubjectFull: Comorbidity
        Type: general
      – SubjectFull: Norway
        Type: general
      – SubjectFull: Aberrant Behavior Checklist
        Type: general
    Titles:
      – TitleFull: Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability
        Type: main
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            NameFull: Erlend Refseth Pedersen
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            NameFull: Audny Anke
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            NameFull: Silje Marie Tessem
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            NameFull: Monica Isabel Olsen
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            NameFull: Erik Søndenaa
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            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1931-5864
            – Type: issn-electronic
              Value: 1931-5872
          Numbering:
            – Type: volume
              Value: 18
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            – TitleFull: Journal of Mental Health Research in Intellectual Disabilities
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