Page 137 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

General discussion
was primarily completed by parents (86%), which likely contributed to the
better recognition of PTSD symptoms by proxy. Parents are usually closely
involved in their children’s daily lives, unlike many professional caregivers,
who often have limited insight into their clients’ trauma history (Hoogstad
et al., 2024). The findings from Study 2 indicate that the TS-ID self-report
version is a psychometrically reliable and valid instrument for screening for
PTSD in adults with MID-BIF. This enables the identification of PTSD cases
that might otherwise have gone unnoticed in adults with MID-BIF. The TS-ID
self-report version represents a crucial step in recognising PTSD in adults
with MID-BIF, facilitating earlier identification and better access to trauma
treatment.
When interpreting this key finding, several limitations should be taken into
account. First, according to the DSM-5-TR, determining whether an individual
meets criteria for ID should not rely solely on IQ scores. Assessment of
adaptive functioning is equally important in determining whether an
individual meets diagnostic criteria for ID. In clinical practice and research,
the term BIF is often used for individuals with IQ scores roughly between 70
and 85, although BIF is not defined as a formal diagnostic category in the
DSM-5-TR and guidance on its specific characteristics and assessment is
limited. In Study 1 and 2 (Chapter 3 and 4), all participants had previously
been identified as having MID or BIF in their client file. However, in many
cases, this was primarily based on IQ scores, with limited information
available on adaptive functioning. As a result, it cannot be established with
certainty whether all participants would meet the current DSM-5-TR criteria
for MID, or whether they would fall within the commonly used range of BIF
based on a comprehensive assessment of adaptive functioning. Second,
we investigated a specific sample of adults with MID-BIF in Study 1 and 2
(Chapter 3 and 4), all living in supported housing of ID care services in the
Netherlands, which may limit the generalisability of the findings.
This key finding has several implications for clinical practice. First, the TS-ID
can be used not only when PTSD is suspected in adults with MID-BIF, but
also if they present with behavioural or psychological problems. As described
above, PTSD symptoms in this group are often masked by behavioural
problems or overshadowed by other mental disorders or characteristics of
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