Prevalence and Patterns of Depressive Disorder Among Children and Adolescents with Intellectual Disability in Sokoto, Northwest Nigeria

Prevalence and Patterns of Depressive Disorder Among Children and Adolescents with Intellectual Disability in Sokoto, Northwest Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Patterns of Depressive Disorder Among Children and Adolescents with Intellectual Disability in Sokoto, Northwest Nigeria Zubairu Umar, Adebayo Sunday Adebisi, Ahmad Abubakar, Abdulaziz Hadi Ibrahim, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7560351/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Depression is a significant comorbidity in children and adolescents with intellectual disability (ID), adversely affecting their quality of life and functional outcomes. While data from high-income countries exist, there is a critical scarcity of epidemiological studies on this subject in Sub-Saharan Africa, including Nigeria. This study aimed to determine the prevalence and socio-demographic and clinical correlates of depressive disorder among children and adolescents with ID in Northwestern Nigeria. Methods A cross-sectional study was conducted among 87 students with ID aged 6–18 years at a residential special school in Sokoto, Nigeria. Intellectual functioning was assessed using Raven's Progressive Matrices. Depression was diagnosed using the Kiddie-SADS-PL, administered by trained clinicians with adaptations for participants with limited verbal abilities, following the Diagnostic Manual–Intellectual Disability (DM-ID) guidelines. Data on socio-demographic and clinical characteristics were collected via a structured questionnaire. Multivariate logistic regression was used to identify independent determinants of depression. Results The overall prevalence of depressive disorder was 19.5% (17/87). A significant gender disparity was observed, with females being disproportionately affected (34.5%, 10/29) compared to males (12.1%, 7/58) (χ²=6.178, p = 0.013). The prevalence varied across levels of intellectual disability: mild ID (20.0%, 1/5), moderate ID (28.6%, 12/42), severe ID (10.5%, 4/38), and profound ID (0.0%, 0/2); however, this association was not statistically significant (p = 0.215). Multivariate analysis identified female gender (OR = 15.43, 95% CI: 1.89–125.85, p = 0.011), having an unemployed father (OR = 21.64, 95% CI: 1.22–384.37, p = 0.036), and lower paternal education (primary/secondary vs. tertiary: OR = 0.045, 95% CI: 0.01–0.31, p = 0.002) as significant independent correlates of depressive disorder. Conclusions Depression is highly prevalent among children and adolescents with intellectual disability in Northwestern Nigeria, with nearly one in five affected. The findings reveal significant vulnerability associated with female gender and socioeconomic factors like paternal unemployment and education. These results underscore the urgent need for integrating routine mental health screening and targeted, gender-sensitive interventions into the standard care provided at special education institutions in Nigeria and similar resource-limited contexts. Intellectual disability Depression Prevalence Children Adolescents Socioeconomic factors Nigeria Sub-Saharan Africa Background Intellectual disability (ID) is a major neurodevelopmental disorder affecting approximately 1–3% of the global population, with a higher estimated prevalence in low- and middle-income countries (LMICs) due to factors like poverty, malnutrition, and limited access to healthcare [1, 2]. Individuals with ID are at a significantly elevated risk for co-occurring mental health conditions, with prevalence rates 4–5 times higher than in the general population [3, 4]. Among these, depressive disorders are particularly common and debilitating, exacerbating functional impairments and diminishing quality of life [5]. The recognition and diagnosis of depression in this population are often complicated by "diagnostic overshadowing," where symptoms are misattributed to the intellectual disability itself, and by communication challenges that mask typical presentations of depression [6, 7]. Consequently, depression remains under-detected and undertreated, especially in resource-limited settings where mental health expertise is scarce. In Sub-Saharan Africa (SSA), the mental health of children with ID is a profoundly neglected area. Epidemiological data is extremely limited, and mental health services are rarely integrated into special education programs [8, 9]. Understanding the scale of the problem is the first critical step towards advocacy, resource allocation, and the development of targeted interventions. Previous Nigerian studies have focused on behavioral problems in general but have not specifically reported on the prevalence of diagnosed depressive disorders using standardized clinical interviews in this population [10]. This study aimed to address this gap by determining the prevalence and exploring the socio-demographic and clinical correlates of depressive disorder among children and adolescents with ID in a special school in Northwestern Nigeria. The findings are intended to provide a baseline for public health action and to highlight subgroups that may require prioritized intervention. Methods Study Design and Setting This cross-sectional study was conducted at the A.A. Raji Special School, Sokoto, the only government-funded special education boarding school in Northwestern Nigeria. The school caters to students with intellectual, hearing, and visual impairments. Participants Eighty-seven children and adolescents with a confirmed diagnosis of ID, aged 6 to 18 years, were recruited via simple random sampling from a total of 97 eligible students at the school. Parents/guardians provided written informed consent, and participant assent was obtained where possible. Ethical Approval Ethical approval was granted by the Sokoto State Ministry of Health Health Research Ethics Committee (Ref: SKHREC/076/2023). All procedures were performed in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments. Instruments and Measures Socio-demographic Questionnaire: A researcher-administered tool collected data on age, gender, ethnicity, family type, parental education, occupation, and socioeconomic status (assessed using the Olusanya et al. method [11]). Anthropometric Measures: Body weight and height were measured using calibrated digital scales. Body Mass Index (BMI) was calculated and classified. Intellectual Functioning Assessment: Raven's Standard Progressive Matrices (RSPM) were used to assess IQ and classify ID severity into: Mild (IQ 50-70), Moderate (IQ 35-50), Severe (IQ 20-35), and Profound (IQ <20) [12]. Depressive Disorder Diagnosis: Current major depressive episode was diagnosed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) [13]. The interviews were conducted by trained psychiatry residents. For non-verbal or minimally verbal participants, the interview was conducted with primary caregivers, focusing on observable behavioral changes (e.g., anhedonia, irritability, psychomotor agitation, sleep/appetite changes) as per the guidelines of the Diagnostic Manual--Intellectual Disability (DM-ID) [7]. Data Analysis Data were analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages, means, and standard deviations) were computed. The prevalence of depression was calculated overall and across subgroups. Associations between categorical variables and depression were examined using Chi-square or Fisher's exact tests. Independent variables with significant bivariate associations (p < 0.05) were entered into a multivariate logistic regression model to identify determinants of depressive disorder. A p-value of <0.05 was considered statistically significant. Results Sample Characteristics The mean age of the participants was 13.09 years (±2.8). The sample consisted of 58 males (66.7%) and 29 females (33.3%). The majority (92.0%) were of Hausa ethnicity and Muslim (92.0%). Over half (52.9%) were from lower socioeconomic backgrounds, and 60.9% had fathers who were unemployed. The distribution of intellectual disability severity was as follows: Mild ID: 5.7% (n=5), Moderate ID: 48.3% (n=42), Severe ID: 43.7% (n=38), and Profound ID: 2.3% (n=2). Prevalence of Depressive Disorder The overall prevalence of depressive disorder was 19.5% (17 out of 87 participants). Patterns and Correlates of Prevalence A stark gender disparity was observed. The prevalence among females was 34.5% (10 out of 29), which was 2.85 times higher than the prevalence among males, which was 12.1% (7 out of 58). This difference was statistically significant (χ²=6.178, p=0.013). Bivariate analysis showed significant associations between depressive disorder and age group (p=0.016), socioeconomic status (p=0.016), father's education level (p<0.001), and father's occupation (p=0.010). The prevalence across IQ levels showed a non-linear pattern (Mild: 20.0%; Moderate: 28.6%; Severe: 10.5%; Profound: 0.0%) but was not statistically significant (p=0.215). No significant associations were found with BMI, ethnicity, or family type. Multivariate Logistic Regression Variables significant at the bivariate level were included in a multivariate model. The analysis confirmed three independent determinants of depressive disorder: Female Gender: Adolescents who were female had 15.43 times higher odds of having depression compared to males (95% CI: 1.89–125.85, p=0.011). Paternal Unemployment: Participants with unemployed fathers had 21.64 times higher odds of depression compared to those with employed fathers (95% CI: 1.22–384.37, p=0.036). Paternal Education: Having a father with only primary/secondary education was associated with significantly higher odds of depression compared to having a father with tertiary education (OR = 0.045, 95% CI: 0.01–0.31, p=0.002). Discussion This study reveals a high prevalence of depressive disorder (19.5%) among children and adolescents with intellectual disability in Northwestern Nigeria. This rate is substantially higher than the 2.3% - 5.4% reported in studies from India, Israel, and the UK [14-16], but aligns with suggestions that emotional and behavioral problems are elevated in children with ID in LMIC settings [10]. This elevated prevalence may be attributed to the confluence of factors such as pervasive stigma, limited access to support services, higher levels of psychosocial adversity, and the specific socio-cultural context of Northern Nigeria. The most striking finding is the significant gender disparity, with girls being nearly three times more likely to be diagnosed with depression than boys. This aligns with established trends in the general adolescent population and is likely compounded for girls with ID in this region by double marginalization—based on both disability and gender—potentially exposing them to greater social isolation, victimization, and restricted opportunities [17]. The study uniquely identifies low paternal education and paternal unemployment as strong independent socioeconomic correlates of depression. This suggests that family socioeconomic stress and potentially lower mental health literacy or resource allocation within the household significantly impact the mental wellbeing of children with ID. The observed trend of depression across IQ levels, with the peak in the moderate ID group, offers clinical insight but was not statistically significant, possibly due to the limited sample size in the mild and profound categories. It partially supports the "social awareness hypothesis," which suggests that individuals with moderate ID possess enough cognitive capacity to perceive their differences and societal rejection, yet may lack the sophisticated cognitive and emotional coping mechanisms, creating a "risk window" for psychological distress [18, 19]. Limitations The cross-sectional design precludes causal inference. The small sample size in the mild and profound ID categories limited the statistical power to detect a significant association with IQ level. The use of a single residential school sample may affect generalizability. A major strength is the use of a standardized, clinician-administered diagnostic interview (K-SADS-PL) with adaptations for ID, which is a more robust method than relying solely on parent-report questionnaires. Conclusions This study provides compelling evidence that depression is a common and serious comorbidity among children and adolescents with intellectual disability in Nigeria, with a pronounced burden on females and those from lower socioeconomic backgrounds. The findings have several critical implications: Integrate Mental Health into Special Education: There is an urgent need to integrate routine, mandatory mental health screening into the services provided at special schools. Develop Targeted Interventions: Mental health programs must be designed with a specific focus on addressing the unique vulnerabilities of girls with ID and providing support for families facing socioeconomic challenges. Combat Diagnostic Overshadowing: Training for healthcare workers, teachers, and caregivers is essential to improve the recognition of depression in children with all levels of ID. Policy Advocacy: These findings should be used to advocate for increased allocation of resources and the development of national guidelines for the mental health care of children with developmental disabilities. Addressing the mental health needs of this vulnerable population is not merely a clinical necessity but a fundamental issue of equity and human rights. Abbreviations ID Intellectual Disability K-SADS-PL Kiddie’s Schedule for Affective Disorders and Schizophrenia Present and Lifetime DM-ID Diagnostic Manual–Intellectual Disability BMI Body Mass Index RSPM Raven's Standard Progressive Matrices LMIC Low- and Middle-Income Country. Declarations Ethics approval and consent to participate: Ethical approval was granted by the Sokoto State Ministry of Health Health Research Ethics Committee (Ref: SKHREC/076/2023). Written informed consent was obtained from all parents/guardians, and assent was obtained from participants where possible. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The author declares that he has no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author's contributions: ZU is the sole author. He conceived the study, designed the methodology, collected and analyzed the data, and wrote the manuscript. Acknowledgements: The author acknowledges the support of the staff and students of A.A. Raji Special School, Sokoto, and the research assistants involved in data collection. References Maulik, P. K., et al. (2011). Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil, 32(2), 419-436. McKenzie, K., et al. (2016). Systematic review of the prevalence and incidence of intellectual disabilities: current trends and issues. Curr Dev Disord Rep, 3(2), 104-115. Einfeld, S. L., & Tonge, B. J. (1996). Population prevalence of psychopathology in children and adolescents with intellectual disability: I. Rationale and methods. J Intellect Disabil Res, 40(2), 91–98. Dekker, M. C., & Koot, H. M. (2003). DSM-IV disorders in children with borderline to moderate intellectual disability. I: prevalence and impact. J Am Acad Child Adolesc Psychiatry, 42(8), 915-922. Adams, D., & Oliver, C. (2010). The relationship between acquired impairments of executive function and behaviour change in adults with Down syndrome. J Intellect Disabil Res, 54(5), 393-405. Reiss, S., Levitan, G. W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. Am J Ment Defic, 86(6), 567-574. Fletcher, R. J., Barnhill, J., & Cooper, S. A. (2016). Diagnostic Manual--Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability (2nd ed.). NADD Press. World Health Organization. (2010). Equity, social determinants and public health programmes. Geneva: World Health Organization. Bakare, M. O., & Munir, K. M. (2011). Excess of non-verbal cases of autism spectrum disorders presenting to orthodox clinical practice in Africa -- a trend possibly resulting from late diagnosis and intervention. S Afr J Psychiatry, 17(4), 118-120. Bakare, M. O., Ubochi, V. N., Ebigbo, P. O., & Orowvigho, A. O. (2010). Problem and prosocial behavior among Nigerian children with intellectual disability: the implication for developing policy for school-based mental health programs. Ital J Pediatr, 36(1), 37. Olusanya, O. (1985). The importance of social class in voluntary fertility control in a developing country. West Afr J Med, 4, 205-212. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Kaufman, J., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry, 36(7), 980-988. Lakhan, R. (2013). The coexistence of psychiatric disorders and intellectual disability in children aged 3–18 years in the Barwani district, India. ISRN Psychiatry, 2013, 875873. Green, T., et al. (2009). Psychiatric disorders and intellectual functioning throughout development in velocardiofacial (22q11.2 deletion) syndrome. J Am Acad Child Adolesc Psychiatry, 48(11), 1060-1068. Emerson, E., & Hatton, C. (2007). The mental health of children and adolescents with intellectual disabilities in Britain. Br J Psychiatry, 191(6), 493-499. Plan International. (2013). Because I am a Girl: The State of the World's Girls 2013 - In Double Jeopardy: Adolescent Girls and Disasters. Plan International. Adams, D., & Oliver, C. (2010). The relationship between acquired impairments of executive function and behaviour change in adults with Down syndrome. J Intellect Disabil Res, 54(5), 393-405. Esbensen, A. J., & Benson, B. A. (2006). A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability. J Intellect Disabil Res, 50(4), 248-258. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7560351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516630849,"identity":"67ae639d-4957-4454-b150-0e41307cc361","order_by":0,"name":"Zubairu Umar","email":"","orcid":"","institution":"Federal Neuropsychiatric Hospital kware Sokoto","correspondingAuthor":false,"prefix":"","firstName":"Zubairu","middleName":"","lastName":"Umar","suffix":""},{"id":516630850,"identity":"c890d86f-66b6-465c-9da0-cb716a690852","order_by":1,"name":"Adebayo Sunday Adebisi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYFCCBDYEI4FBQg4mzthArBZjErUAQSJMJU4t/O3Jxx78bLOBMB78sUjfLt2d+LmAwUZ2wwHewy+waJE48yzdsLctDcwwSGyTyN055+xm6RkMacYbDvClWWCz5kaOmQRv22EII7FBInfDjdxtzDwMhxM3HOAxM8CiQ/5G/jfJv0AtIIZEwh+JdAOIlv84tRjcyGGTBtkCYkgkABFUywGQFuMHWLQYnnlmbixzLo0HxAD5xXDDHaBfeAySjWce5jHD5hW548nPHr4ps5EDM378qZM3uN278TNPhZ1s3/Ee4w84ApqBkY2BBykQwQ4GYmYGNglcWhj+IHOQlDHjtGUUjIJRMApGEgAAKz9qN4Pi1nsAAAAASUVORK5CYII=","orcid":"","institution":"Federal Neuropsychiatric Hospital kware Sokoto","correspondingAuthor":true,"prefix":"","firstName":"Adebayo","middleName":"Sunday","lastName":"Adebisi","suffix":""},{"id":516630852,"identity":"cd4a6dba-fce3-4168-ac32-ac51b00d1498","order_by":2,"name":"Ahmad Abubakar","email":"","orcid":"","institution":"Federal Neuropsychiatric Hospital kware Sokoto","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Abubakar","suffix":""},{"id":516630853,"identity":"5c58334f-d1f8-4212-af52-bc3b0ace1a38","order_by":3,"name":"Abdulaziz Hadi Ibrahim","email":"","orcid":"","institution":"Federal Neuropsychiatric Hospital kware Sokoto Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Abdulaziz","middleName":"Hadi","lastName":"Ibrahim","suffix":""},{"id":516630854,"identity":"331243b9-84f8-4978-a933-8eeccf0284bd","order_by":4,"name":"Folorunsho Nuhu Muftau","email":"","orcid":"","institution":"Folorunsho Nuhu Muftau Federal Neuropsychiatric Hospital kaduna","correspondingAuthor":false,"prefix":"","firstName":"Folorunsho","middleName":"Nuhu","lastName":"Muftau","suffix":""},{"id":516630855,"identity":"e4812f9b-ab3c-4e02-8f00-5587c9c1b48e","order_by":5,"name":"Junaidu Sarki","email":"","orcid":"","institution":"Federal Neuropsychiatric Hospital kware Sokoto Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Junaidu","middleName":"","lastName":"Sarki","suffix":""}],"badges":[],"createdAt":"2025-09-08 05:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7560351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7560351/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92032769,"identity":"c50779c7-1936-4452-ae52-baaa83ad1913","added_by":"auto","created_at":"2025-09-23 22:18:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16962,"visible":true,"origin":"","legend":"","description":"","filename":"prevalence1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/a9271e813190f105364c4ce2.docx"},{"id":92032767,"identity":"cf67f995-08c0-4a9e-8fb6-f08f796963ef","added_by":"auto","created_at":"2025-09-23 22:18:15","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8439,"visible":true,"origin":"","legend":"","description":"","filename":"3c2a3ff1a7484f92b3635348d77b720a.json","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/51ba65d6988783dc2d1ece89.json"},{"id":92032768,"identity":"85eeced0-98d5-4db7-892e-baf24556e959","added_by":"auto","created_at":"2025-09-23 22:18:15","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":37222,"visible":true,"origin":"","legend":"","description":"","filename":"3c2a3ff1a7484f92b3635348d77b720a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/64e0d793ba8800f2471eb39d.xml"},{"id":92032771,"identity":"d58bd1d8-df55-4caa-bc01-c7384701ad69","added_by":"auto","created_at":"2025-09-23 22:18:15","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36007,"visible":true,"origin":"","legend":"","description":"","filename":"3c2a3ff1a7484f92b3635348d77b720a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/92702fb5490d1f4edb7efc38.xml"},{"id":92032770,"identity":"2bd94b62-8845-4629-97c1-8add20e734a1","added_by":"auto","created_at":"2025-09-23 22:18:15","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44964,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/f98f6bfbf1edbdcdfb6a9276.html"},{"id":92309061,"identity":"3bbaeaa4-589e-4ab9-b06c-d801e3136a64","added_by":"auto","created_at":"2025-09-27 09:02:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":650177,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7560351/v1/934825c9-2a4e-432b-a044-f7654392bcfe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Patterns of Depressive Disorder Among Children and Adolescents with Intellectual Disability in Sokoto, Northwest Nigeria","fulltext":[{"header":"Background","content":"\u003cp\u003eIntellectual disability (ID) is a major neurodevelopmental disorder affecting approximately 1\u0026ndash;3% of the global population, with a higher estimated prevalence in low- and middle-income countries (LMICs) due to factors like poverty, malnutrition, and limited access to healthcare [1, 2]. Individuals with ID are at a significantly elevated risk for co-occurring mental health conditions, with prevalence rates 4\u0026ndash;5 times higher than in the general population [3, 4]. Among these, depressive disorders are particularly common and debilitating, exacerbating functional impairments and diminishing quality of life [5].\u003c/p\u003e\u003cp\u003eThe recognition and diagnosis of depression in this population are often complicated by \"diagnostic overshadowing,\" where symptoms are misattributed to the intellectual disability itself, and by communication challenges that mask typical presentations of depression [6, 7]. Consequently, depression remains under-detected and undertreated, especially in resource-limited settings where mental health expertise is scarce.\u003c/p\u003e\u003cp\u003eIn Sub-Saharan Africa (SSA), the mental health of children with ID is a profoundly neglected area. Epidemiological data is extremely limited, and mental health services are rarely integrated into special education programs [8, 9]. Understanding the scale of the problem is the first critical step towards advocacy, resource allocation, and the development of targeted interventions. Previous Nigerian studies have focused on behavioral problems in general but have not specifically reported on the prevalence of diagnosed depressive disorders using standardized clinical interviews in this population [10].\u003c/p\u003e\u003cp\u003eThis study aimed to address this gap by determining the prevalence and exploring the socio-demographic and clinical correlates of depressive disorder among children and adolescents with ID in a special school in Northwestern Nigeria. The findings are intended to provide a baseline for public health action and to highlight subgroups that may require prioritized intervention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e This cross-sectional study was conducted at the A.A. Raji Special School, Sokoto, the only government-funded special education boarding school in Northwestern Nigeria. The school caters to students with intellectual, hearing, and visual impairments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e Eighty-seven children and adolescents with a confirmed diagnosis of ID, aged 6 to 18 years, were recruited via simple random sampling from a total of 97 eligible students at the school. Parents/guardians provided written informed consent, and participant assent was obtained where possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e Ethical approval was granted by the Sokoto State Ministry of Health Health Research Ethics Committee (Ref: SKHREC/076/2023). All procedures were performed in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments and Measures\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eSocio-demographic Questionnaire:\u003c/strong\u003e A researcher-administered tool collected data on age, gender, ethnicity, family type, parental education, occupation, and socioeconomic status (assessed using the Olusanya et al. method [11]).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAnthropometric Measures:\u003c/strong\u003e Body weight and height were measured using calibrated digital scales. Body Mass Index (BMI) was calculated and classified.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntellectual Functioning Assessment:\u003c/strong\u003e Raven\u0026apos;s Standard Progressive Matrices (RSPM) were used to assess IQ and classify ID severity into: Mild (IQ 50-70), Moderate (IQ 35-50), Severe (IQ 20-35), and Profound (IQ \u0026lt;20) [12].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDepressive Disorder Diagnosis:\u003c/strong\u003e Current major depressive episode was diagnosed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) [13]. The interviews were conducted by trained psychiatry residents. For non-verbal or minimally verbal participants, the interview was conducted with primary caregivers, focusing on observable behavioral changes (e.g., anhedonia, irritability, psychomotor agitation, sleep/appetite changes) as per the guidelines of the Diagnostic Manual--Intellectual Disability (DM-ID) [7].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e Data were analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages, means, and standard deviations) were computed. The prevalence of depression was calculated overall and across subgroups. Associations between categorical variables and depression were examined using Chi-square or Fisher\u0026apos;s exact tests. Independent variables with significant bivariate associations (p \u0026lt; 0.05) were entered into a multivariate logistic regression model to identify determinants of depressive disorder. A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSample Characteristics\u003c/strong\u003e The mean age of the participants was 13.09 years (\u0026plusmn;2.8). The sample consisted of 58 males (66.7%) and 29 females (33.3%). The majority (92.0%) were of Hausa ethnicity and Muslim (92.0%). Over half (52.9%) were from lower socioeconomic backgrounds, and 60.9% had fathers who were unemployed. The distribution of intellectual disability severity was as follows: Mild ID: 5.7% (n=5), Moderate ID: 48.3% (n=42), Severe ID: 43.7% (n=38), and Profound ID: 2.3% (n=2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Depressive Disorder\u003c/strong\u003e The overall prevalence of depressive disorder was 19.5% (17 out of 87 participants).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatterns and Correlates of Prevalence\u003c/strong\u003e A stark gender disparity was observed. The prevalence among females was 34.5% (10 out of 29), which was 2.85 times higher than the prevalence among males, which was 12.1% (7 out of 58). This difference was statistically significant (\u0026chi;\u0026sup2;=6.178, p=0.013).\u003c/p\u003e\n\u003cp\u003eBivariate analysis showed significant associations between depressive disorder and age group (p=0.016), socioeconomic status (p=0.016), father\u0026apos;s education level (p\u0026lt;0.001), and father\u0026apos;s occupation (p=0.010). The prevalence across IQ levels showed a non-linear pattern (Mild: 20.0%; Moderate: 28.6%; Severe: 10.5%; Profound: 0.0%) but was not statistically significant (p=0.215). No significant associations were found with BMI, ethnicity, or family type.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate Logistic Regression\u003c/strong\u003e Variables significant at the bivariate level were included in a multivariate model. The analysis confirmed three independent determinants of depressive disorder:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eFemale Gender:\u003c/strong\u003e Adolescents who were female had 15.43 times higher odds of having depression compared to males (95% CI: 1.89\u0026ndash;125.85, p=0.011).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePaternal Unemployment:\u003c/strong\u003e Participants with unemployed fathers had 21.64 times higher odds of depression compared to those with employed fathers (95% CI: 1.22\u0026ndash;384.37, p=0.036).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePaternal Education:\u003c/strong\u003e Having a father with only primary/secondary education was associated with significantly higher odds of depression compared to having a father with tertiary education (OR = 0.045, 95% CI: 0.01\u0026ndash;0.31, p=0.002).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study reveals a high prevalence of depressive disorder (19.5%) among children and adolescents with intellectual disability in Northwestern Nigeria. This rate is substantially higher than the 2.3% - 5.4% reported in studies from India, Israel, and the UK [14-16], but aligns with suggestions that emotional and behavioral problems are elevated in children with ID in LMIC settings [10]. This elevated prevalence may be attributed to the confluence of factors such as pervasive stigma, limited access to support services, higher levels of psychosocial adversity, and the specific socio-cultural context of Northern Nigeria.\u003c/p\u003e\n\u003cp\u003eThe most striking finding is the significant gender disparity, with girls being nearly three times more likely to be diagnosed with depression than boys. This aligns with established trends in the general adolescent population and is likely compounded for girls with ID in this region by double marginalization\u0026mdash;based on both disability and gender\u0026mdash;potentially exposing them to greater social isolation, victimization, and restricted opportunities [17].\u003c/p\u003e\n\u003cp\u003eThe study uniquely identifies low paternal education and paternal unemployment as strong independent socioeconomic correlates of depression. This suggests that family socioeconomic stress and potentially lower mental health literacy or resource allocation within the household significantly impact the mental wellbeing of children with ID.\u003c/p\u003e\n\u003cp\u003eThe observed trend of depression across IQ levels, with the peak in the moderate ID group, offers clinical insight but was not statistically significant, possibly due to the limited sample size in the mild and profound categories. It partially supports the \u0026quot;social awareness hypothesis,\u0026quot; which suggests that individuals with moderate ID possess enough cognitive capacity to perceive their differences and societal rejection, yet may lack the sophisticated cognitive and emotional coping mechanisms, creating a \u0026quot;risk window\u0026quot; for psychological distress [18, 19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e The cross-sectional design precludes causal inference. The small sample size in the mild and profound ID categories limited the statistical power to detect a significant association with IQ level. The use of a single residential school sample may affect generalizability. A major strength is the use of a standardized, clinician-administered diagnostic interview (K-SADS-PL) with adaptations for ID, which is a more robust method than relying solely on parent-report questionnaires.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides compelling evidence that depression is a common and serious comorbidity among children and adolescents with intellectual disability in Nigeria, with a pronounced burden on females and those from lower socioeconomic backgrounds. The findings have several critical implications:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eIntegrate Mental Health into Special Education:\u003c/strong\u003e There is an urgent need to integrate routine, mandatory mental health screening into the services provided at special schools.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDevelop Targeted Interventions:\u003c/strong\u003e Mental health programs must be designed with a specific focus on addressing the unique vulnerabilities of girls with ID and providing support for families facing socioeconomic challenges.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCombat Diagnostic Overshadowing:\u003c/strong\u003e Training for healthcare workers, teachers, and caregivers is essential to improve the recognition of depression in children with all levels of ID.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePolicy Advocacy:\u003c/strong\u003e These findings should be used to advocate for increased allocation of resources and the development of national guidelines for the mental health care of children with developmental disabilities.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAddressing the mental health needs of this vulnerable population is not merely a clinical necessity but a fundamental issue of equity and human rights.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eID\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntellectual Disability\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eK-SADS-PL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKiddie\u0026rsquo;s Schedule for Affective Disorders and Schizophrenia Present and Lifetime\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eDM-ID\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiagnostic Manual\u0026ndash;Intellectual Disability\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eRSPM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRaven's Standard Progressive Matrices\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eLMIC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow- and Middle-Income Country.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical approval was granted by the Sokoto State Ministry of Health Health Research Ethics Committee (Ref: SKHREC/076/2023). Written informed consent was obtained from all parents/guardians, and assent was obtained from participants where possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The author declares that he has no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s contributions:\u003c/strong\u003e ZU is the sole author. He conceived the study, designed the methodology, collected and analyzed the data, and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The author acknowledges the support of the staff and students of A.A. Raji Special School, Sokoto, and the research assistants involved in data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaulik, P. K., et al. (2011). Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil, 32(2), 419-436.\u003c/li\u003e\n\u003cli\u003eMcKenzie, K., et al. (2016). Systematic review of the prevalence and incidence of intellectual disabilities: current trends and issues. Curr Dev Disord Rep, 3(2), 104-115.\u003c/li\u003e\n\u003cli\u003eEinfeld, S. L., \u0026amp; Tonge, B. J. (1996). Population prevalence of psychopathology in children and adolescents with intellectual disability: I. Rationale and methods. J Intellect Disabil Res, 40(2), 91\u0026ndash;98.\u003c/li\u003e\n\u003cli\u003eDekker, M. C., \u0026amp; Koot, H. M. (2003). DSM-IV disorders in children with borderline to moderate intellectual disability. I: prevalence and impact. J Am Acad Child Adolesc Psychiatry, 42(8), 915-922.\u003c/li\u003e\n\u003cli\u003eAdams, D., \u0026amp; Oliver, C. (2010). The relationship between acquired impairments of executive function and behaviour change in adults with Down syndrome. J Intellect Disabil Res, 54(5), 393-405.\u003c/li\u003e\n\u003cli\u003eReiss, S., Levitan, G. W., \u0026amp; Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. Am J Ment Defic, 86(6), 567-574.\u003c/li\u003e\n\u003cli\u003eFletcher, R. J., Barnhill, J., \u0026amp; Cooper, S. A. (2016). Diagnostic Manual--Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability (2nd ed.). NADD Press.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2010). Equity, social determinants and public health programmes. Geneva: World Health Organization.\u003c/li\u003e\n\u003cli\u003eBakare, M. O., \u0026amp; Munir, K. M. (2011). Excess of non-verbal cases of autism spectrum disorders presenting to orthodox clinical practice in Africa -- a trend possibly resulting from late diagnosis and intervention. S Afr J Psychiatry, 17(4), 118-120.\u003c/li\u003e\n\u003cli\u003eBakare, M. O., Ubochi, V. N., Ebigbo, P. O., \u0026amp; Orowvigho, A. O. (2010). Problem and prosocial behavior among Nigerian children with intellectual disability: the implication for developing policy for school-based mental health programs. Ital J Pediatr, 36(1), 37.\u003c/li\u003e\n\u003cli\u003eOlusanya, O. (1985). The importance of social class in voluntary fertility control in a developing country. West Afr J Med, 4, 205-212.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).\u003c/li\u003e\n\u003cli\u003eKaufman, J., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry, 36(7), 980-988.\u003c/li\u003e\n\u003cli\u003eLakhan, R. (2013). The coexistence of psychiatric disorders and intellectual disability in children aged 3\u0026ndash;18 years in the Barwani district, India. ISRN Psychiatry, 2013, 875873.\u003c/li\u003e\n\u003cli\u003eGreen, T., et al. (2009). Psychiatric disorders and intellectual functioning throughout development in velocardiofacial (22q11.2 deletion) syndrome. J Am Acad Child Adolesc Psychiatry, 48(11), 1060-1068.\u003c/li\u003e\n\u003cli\u003eEmerson, E., \u0026amp; Hatton, C. (2007). The mental health of children and adolescents with intellectual disabilities in Britain. Br J Psychiatry, 191(6), 493-499.\u003c/li\u003e\n\u003cli\u003ePlan International. (2013). Because I am a Girl: The State of the World\u0026apos;s Girls 2013 - In Double Jeopardy: Adolescent Girls and Disasters. Plan International.\u003c/li\u003e\n\u003cli\u003eAdams, D., \u0026amp; Oliver, C. (2010). The relationship between acquired impairments of executive function and behaviour change in adults with Down syndrome. J Intellect Disabil Res, 54(5), 393-405.\u003c/li\u003e\n\u003cli\u003eEsbensen, A. J., \u0026amp; Benson, B. A. (2006). A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability. J Intellect Disabil Res, 50(4), 248-258.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intellectual disability, Depression, Prevalence, Children, Adolescents, Socioeconomic factors, Nigeria, Sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-7560351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7560351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDepression is a significant comorbidity in children and adolescents with intellectual disability (ID), adversely affecting their quality of life and functional outcomes. While data from high-income countries exist, there is a critical scarcity of epidemiological studies on this subject in Sub-Saharan Africa, including Nigeria. This study aimed to determine the prevalence and socio-demographic and clinical correlates of depressive disorder among children and adolescents with ID in Northwestern Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted among 87 students with ID aged 6\u0026ndash;18 years at a residential special school in Sokoto, Nigeria. Intellectual functioning was assessed using Raven's Progressive Matrices. Depression was diagnosed using the Kiddie-SADS-PL, administered by trained clinicians with adaptations for participants with limited verbal abilities, following the Diagnostic Manual\u0026ndash;Intellectual Disability (DM-ID) guidelines. Data on socio-demographic and clinical characteristics were collected via a structured questionnaire. Multivariate logistic regression was used to identify independent determinants of depression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall prevalence of depressive disorder was 19.5% (17/87). A significant gender disparity was observed, with females being disproportionately affected (34.5%, 10/29) compared to males (12.1%, 7/58) (χ\u0026sup2;=6.178, p\u0026thinsp;=\u0026thinsp;0.013). The prevalence varied across levels of intellectual disability: mild ID (20.0%, 1/5), moderate ID (28.6%, 12/42), severe ID (10.5%, 4/38), and profound ID (0.0%, 0/2); however, this association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.215). Multivariate analysis identified female gender (OR\u0026thinsp;=\u0026thinsp;15.43, 95% CI: 1.89\u0026ndash;125.85, p\u0026thinsp;=\u0026thinsp;0.011), having an unemployed father (OR\u0026thinsp;=\u0026thinsp;21.64, 95% CI: 1.22\u0026ndash;384.37, p\u0026thinsp;=\u0026thinsp;0.036), and lower paternal education (primary/secondary vs. tertiary: OR\u0026thinsp;=\u0026thinsp;0.045, 95% CI: 0.01\u0026ndash;0.31, p\u0026thinsp;=\u0026thinsp;0.002) as significant independent correlates of depressive disorder.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDepression is highly prevalent among children and adolescents with intellectual disability in Northwestern Nigeria, with nearly one in five affected. The findings reveal significant vulnerability associated with female gender and socioeconomic factors like paternal unemployment and education. These results underscore the urgent need for integrating routine mental health screening and targeted, gender-sensitive interventions into the standard care provided at special education institutions in Nigeria and similar resource-limited contexts.\u003c/p\u003e","manuscriptTitle":"Prevalence and Patterns of Depressive Disorder Among Children and Adolescents with Intellectual Disability in Sokoto, Northwest Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 22:18:10","doi":"10.21203/rs.3.rs-7560351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f575ec69-7362-4ecd-9e76-58ed9987a2bc","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-27T08:53:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 22:18:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7560351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7560351","identity":"rs-7560351","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}