Improving functional outcome using compensatory strategies in comorbid intellectual disability and psychosis: A case study

Relative to the general population, people with intellectual disability (ID) are at greater risk of psychosis, with an estimated prevalence of 3%-5%. By definition, ID is associated with significant impairment in adaptive function. Similarly, functional disability is a common residual feature of psychosis. Yet, reports of evidence-based treatment for functional impairment in comorbid ID and psychosis are sparse, with most literature focusing on behavior management. Given that intellectual impairment in ID and psychosis are known to interfere with functional recovery, a treatment that addresses this impairment is paramount. Cognitive adaptation training (CAT) may be a suitable intervention for this purpose, as it is underpinned by the understanding that cognitive abilities play a strong role in community functioning. CAT is a manualized intervention involving the application of multiple external compensatory strategies and environmental supports (e.g., signs, alarms, checklists) that are individually tailored based on assessment of cognition, behavioral/learning type and specific functional goals. This case study will illustrate the use of compensatory strategies and environmental supports, based on the CAT model, to address the functional goals of a young man with mild ID and first-episode psychosis.