A Call for Inclusion: Children With Intellectual Disabilities in Trauma Treatment Research

Children with intellectual disabilities (ID) experience disparities in mental health care despite experiencing increased exposure to trauma such as physical, emotional and sexual abuse. Studies have suggested that the exclusion of people with ID from medical research may contribute to disparities in health care. It is currently unknown to what extent children with ID are excluded from trauma treatment research.

All randomised controlled trials (RCTs) (n = 62) included in the most up-to-date International Society for Traumatic Stress Studies (ISTSS) clinical care guidelines meta-analysis of posttraumatic stress disorder (PTSD) treatments were reanalysed and coded to determine whether or not children with ID or other developmental disabilities that co-occur with ID were excluded based on inclusion/exclusion criteria. Articles were double-coded by the research team. The corresponding authors of the studies were asked to complete a survey rating the likelihood that children with ID would have been eligible for the study.

Of the studies, 61.3% reviewed reported exclusion criteria based on a diagnosis of intellectual disability, cognitive impairment, autism spectrum disorder, organic/neurological conditions, or other related terms (e.g., 'significant learning difficulties'). Operationalisation of exclusion criteria was sparse. Few studies reported the number of children excluded from trials based on an ID diagnosis.

The evidence base for the ISTSS clinical care guidelines of child PTSD treatment is not representative of children with ID. Improved documentation of inclusion/exclusion criteria, reporting of disability as a demographic characteristic, and inclusion of children with ID in PTSD treatment trials are needed to improve representation of children with ID in PTSD research.