Serious psychiatric disorder is two to three times more common in mentally retarded (intellectually disabled) children than in the general population. (12 and 3) The dual disability of psychiatric disorder and mental retardation is a source of major additional handicap and impairment of adaptive behaviour through loss of educational, recreational and social opportunity, personal suffering, distress for carers, and cost to the community. Numerically, this problem is at least equal in size to schizophrenia which has a lifetime prevalence of 1 per cent. Nevertheless, it goes largely unrecognized. For example in the recent World Health Organization Global Burden of Disease Study the presence of mental retardation was not recognized as a powerful risk factor for psychiatric disorder. (4) Lack of recognition of dual disability might be due to diagnostic overshadowing in which psychiatric disorder in persons with mental retardation is identified as simply being a feature of their intellectual handicap and not as a separate condition open to diagnosis and treatment. (5)

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