Adults with intellectual disability and Attention Deficit Hyperactivity Disorder: Clinical characteristics and medication profiles

Al-Khudairi, Rashed; Perera, Bhathika; Solomou, Solomis; Courtenay, Ken

doi:10.1111/bld.12265

Cited by 18 publications

(28 citation statements)

References 39 publications

(39 reference statements)

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“…Similar to other published studies, we also found that ADD was more common among autistic adults without ID (Bishop-Fitzpatrick & Rubenstein, 2019). One possible explanation for this finding may be that, among those with ID, ADDs may be more difficult to diagnose due to diagnostic overshadowing (Al-Khudairi et al, 2019). The higher prevalence of ADDs among autistic older adults without ID may also explain the increased risk of substance use disorders among this group, as prior studies have shown that substance use disorders are most common among autistic adults who have a co-occurring ADD diagnosis (Butwicka et al, 2017).…”

Section: Discussionsupporting

confidence: 91%

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Gilmore

Harris

Longo

et al. 2020

Autism

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Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. We conducted a cross-sectional retrospective cohort study of Medicare claims data from 2016 to 2017 to compare the prevalence of physical and mental health conditions among autistic older adults (age 65+ years) with intellectual disability ( N = 2054) to autistic older adults without intellectual disability ( N = 2631). Medicare claims data consisted of records from inpatient hospitalizations and institutional outpatient visits (i.e. visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers). Examination of the largest between-group differences revealed that autistic older adults with intellectual disability had 350% greater odds of epilepsy (odds ratio = 4.5, 95% confidence interval = 3.9–5.2), 170% greater odds of osteoporosis (odds ratio = 2.7, 95% confidence interval = 2.3–3.2), and 100% greater odds of gastrointestinal conditions (odds ratio = 2.0, 95% confidence interval = 1.8–2.2) but 80% lower odds of attention deficit disorders (odds ratio = 0.2, 95% confidence interval = 0.1–0.3), 70% lower odds of substance use disorders (odds ratio = 0.3, 95% confidence interval = 0.2–0.4), and 60% lower odds of suicidal ideation or intentional self-injury (odds ratio = 0.4, 95% confidence interval = 0.3–0.6). These findings highlight the importance of developing tailored health management strategies for the autistic older adult population as a function of intellectual disability status. Lay abstract Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as “institutional outpatient” healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.

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Section: Discussionsupporting

confidence: 91%

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Gilmore

Harris

Longo

et al. 2020

Autism

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“…For instance, it was already suggested that the diagnosis of ADHD is often missed or misdiagnosed in people with ID as ADHD can be missed and the behaviours attributed to the ID or autism (Perera 2018; Al‐Khudairi et al . 2019). Another reason is that scientific evidence available on the pharmacological treatment of ADHD in DS is limited to case reports and an open‐label trial of guanfacine (Capone et al .…”

Section: Discussionmentioning

confidence: 99%

“…This also might help to reduce the use of psychotropic medications such as antipsychotics (Al‐Khudairi et al . 2019). Moreover, the association of ADHD with ODD is frequent and complicates the life of these children and their families and contributes to learning difficulties and lack of social inclusion.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of methylphenidate on attention deficit hyperactivity disorder in children with Down syndrome

Roche

Mircher

Toulas

et al. 2021

J intellect Disabil Res

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Background Attention deficit hyperactivity disorder (ADHD) is a common co‐morbidity that affects up to 44% of children with Down syndrome (DS). There is a need for reliable, good quality research on the use of methylphenidate within this population. The objective of this study is to report our experience regarding the management of ADHD in these children using methylphenidate. Methods This study is a retrospective observation of 21 children with DS, followed at Jérôme Lejeune Institute between 2000 and 2018. The diagnosis of ADHD was made using the Diagnostic and Statistical Manual of Mental Disorders criteria. Efficacy was measured as response or non‐response on two main symptoms: attention/concentration and hyperactivity/impulsivity. Safety was evaluated by the presence or absence of side effects. Results Sixteen out of the 21 children (76%) showed improvement with methylphenidate. The average age of treatment onset in responding children was 8 years and 10 months versus 6 years and 3 months in non‐responders (P = 0.05). Average dose/weight was significantly different in responders and non‐responders (0.82 vs. 0.54 mg/kg/day, respectively; P = 0.03). Twelve children out of 21 (57%) experienced side effects; only three experienced side effects severe enough to require treatment interruption. Most common side effects were loss of appetite and difficulties in falling asleep. Conclusion Methylphenidate was effective and safe in treating ADHD in 76% of cases in children with DS, with few serious side effects to report. Early diagnosis of ADHD is important to improve the quality of life, learning, inclusion and socialisation of children with DS.

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“…This view could, in turn, contribute to the debate as to why some (but not all) individuals with impaired selective attention, such as ADHD (Brodeur & Pond, 2001;Mueller, Hong, Shepard, & Moore, 2017), perform poorly on the achievement and IQ tests (Frazier, Demaree, & Youngstrom, 2004). Validation of this hypothesis deserves further investigation, particularly given that learning difficulties with reading/arithmetic and attention deficits are often understudied or underestimated in people with borderline intellectual functioning (Al-Khudairi, Perera, Solomou, & Courtenay, 2019;Baglio et al, 2014;Di Blasi, Buono, Cantagallo, Di Filippo, & Zoccolotti, 2019;Jansen, De Lange, & Van der Molen, 2013;E. Rose, Bramham, Young, Paliokostas, & Xenitidis, 2009); such individuals are not often granted eligibility to access specialized healthcare or social/educational services they might need (Martinez & Quirk, 2009).…”

Section: Reho In Thalamus/pulvinarmentioning

confidence: 98%

Thalamus is a common locus of reading, arithmetic, and IQ: Analysis of local intrinsic functional properties

et al. 2020

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Neuroimaging studies of basic achievement skills, reading and arithmetic, often control for the effect of IQ to identify unique neural correlates of each skill. This may underestimate possible effects of common factors between achievement and IQ measures on neuroimaging results. Here, we simultaneously examined achievement (reading and arithmetic) and IQ measures in young adults, aiming to identify MRI correlates of their common factors. Resting-state fMRI (rs-fMRI) data were analyzed using two metrics assessing local intrinsic functional properties; regional homogeneity (ReHo) and fractional amplitude low frequency fluctuation (fALFF), measuring local intrinsic functional connectivity and intrinsic functional activity, respectively. ReHo highlighted the thalamus/pulvinar (a subcortical region implied for selective attention) as a common locus for both achievement skills and IQ. More specifically, the higher the ReHo values, the lower the achievement and IQ scores. For fALFF, the left superior parietal lobule, part of the dorsal attention network, was positively associated with reading and IQ. Collectively, our results highlight attention-related regions, particularly the thalamus/pulvinar as a key region related to individual differences in performance on all the three measures. ReHo in the thalamus/pulvinar may serve as a tool to examine brain mechanisms underlying a comorbidity of reading and arithmetic difficulties, which could co-occur with weakness in general intellectual abilities.

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Adults with intellectual disability and Attention Deficit Hyperactivity Disorder: Clinical characteristics and medication profiles

Cited by 18 publications

References 39 publications

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Efficacy and safety of methylphenidate on attention deficit hyperactivity disorder in children with Down syndrome

Thalamus is a common locus of reading, arithmetic, and IQ: Analysis of local intrinsic functional properties

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