Thank you for publishing Beail's (2003) perspective on what works for people with mental retardation. Beail made valid arguments for (a) his conclusion that the absence of evidence in support of cognitive behavior therapy does not necessarily indicate that it is an ineffective approach and (b) his advocacy for a full range of mental health treatment for people with mental retardation and mental health needs.

There was, however, an essential factor absent from Beail's (2003) discussion, namely, that the unique presentation of many people with intellectual disabilities often requires special clinical skills in both diagnosis and treatment (Bouras, Kon, & Drummond, 1993; Bregman, 1991; Campbell & Malone, 1991; Criscione, Kastner, Walsh, & Nathanson, 1993; Dosen, 1993; Evangelista, 1988; Hurley, 1996; Jacobson, 1990; Sovner, 1986). This does not necessarily suggest that individuals with intellectual disabilities cannot benefit from most treatment modalities; rather, it indicates that clinicians providing treatment must have the training and ability to provide care in the context of the person's intellectual capabilities.

Unfortunately, most mental health professionals who treat individuals with intellectual disabilities have had little to no training in applying their specific treatment modality to people with co-occurring intellectual disabilities and mental health needs. The dearth of both formalized training approaches and training opportunities for clinicians in the provision of psychotherapy for individuals with intellectual disabilities most likely negatively affects treatment outcomes and should be considered an obstacle to accurately test the benefits of specific treatment modalities.

References

References
Beail
,
N.
2003
.
What works for people with mental retardation? Critical commentary on cognitive– behavioral and psychodynamic psychotherapy research.
Mental Retardation
41
:
468
471
.
Bouras
,
N.
,
Y.
Kon
, and
C.
Drummond
.
1993
.
Medical and psychiatric needs of adults with a mental handicap.
Journal of Intellectual Disability Research
37
:
177
182
.
Bregman
,
J. D.
1991
.
Current developments in the understanding of mental retardation Part II: Psychopathology.
Journal of the American Academy of Child and Adolescent Psychiatry
30
:
861
872
.
Campbell
,
M.
and
R.
Malone
.
1991
.
Mental retardation and psychiatric disorders.
Hospital and Community Psychiatry
42
:
374
379
.
Criscione
,
T.
,
T.
Kastner
,
K.
Walsh
, and
R.
Nathanson
.
1993
.
Managed health care systems for people with mental retardation: Impact on patient utilization.
Mental Retardation
31
:
297
306
.
Dosen
,
A.
1993
.
Diagnosis and treatment of psychiatric and behavioral disorders in mentally retarded individuals: The state of the art.
Journal of Intellectual Disability Research
37
:
1
7
.
Evangelista
,
L. A.
1988
.
Comprehensive management of the mentally retarded/mentally ill.
In J. Stark, F. Menolascino, M. Albarelli, & V. Gray (Eds.), Mental retardation and mental health: Classification, diagnosis, treatment services (pp. 140–146). New York: Springer-Verlag
.
Hurley
,
A. D.
1996
.
Vocational rehabilitation approaches to support adults with mental retardation.
Habilitative Mental Healthcare Newsletter
15
:
29
33
.
Jacobson
,
J. W.
1990
.
Assessing the prevalence of psychiatric disorders in the developmentally disabled population.
In E. Dibble & D. Gray (Eds.), Assessment of persons with mental retardation living in the community (pp. 19–70). Rockville, MD: National Institute of Mental Health
.
Sovner
,
R.
1986
.
Limiting factors in the use of DSMIII criteria with mentally ill/ mentally retarded persons.
Psychopharmacology Bulletin
22
:
1055
1059
.

Author notes

Author: Joan B. Beasley, PhD, Consultation and Training Services, 184 Bonad Rd., Chestnut Hill, MA 02467. jbbeasley@rcn.com