Amfetamine for attention deficit hyperactivity disorder in people with intellectual disabilities

Abstract

There is very little evidence for the effectiveness of amfetamine for ADHD in people with ID . Prescribing in this population is based on extrapolation of research in people without ID. More research into effectiveness and tolerability is urgently needed.

A meta‐analysis of intervention effects on challenging behaviour among persons with intellectual disabilities

“…In the general literature and in articles presenting qualitative and descriptive material, some authors claim that there is evidence for the effectiveness of pharmacological treatments (Grey & Hastings 2005;Deb et al 2007), although many authors assert that they lack empirical effectiveness (Brylewski & Duggan 1999;Taylor 2002;La Malfa et al 2006;Sohanpal et al 2007;Antonacci et al 2008;Matson & Neal 2009;Thomson et al 2009aThomson et al , 2009b. Besides, there are many concerns regarding their adverse effects (McGillivray & McCabe 2006;Deb et al 2007;Sohanpal et al 2007).…”

“…Treatment strategies that are frequently employed are biological and psychotherapeutic interventions, sometimes supplemented with contextual strategies (Bouras 1999;Ager & O'May 2001;Dösen & Day 2001;Gavidia-Payne & Hudson 2002;Kahng et al 2002;Taylor 2002;Grey & Hastings 2005;Benson & Brooks 2008;Mildon et al 2008). Recently, some reviews and meta-analytic articles have studied these interventions for challenging behaviour among persons with ID (Brylewski & Duggan 1999;Prout & Nowak-Drabik 2003;Shogren et al 2004;Didden et al 2006;Lotan & Gold 2009;Matson & Neal 2009;Thomson et al 2009aThomson et al , 2009b. None of these articles included both the biological and the psychotherapeutic and contextual interventions, although it is interesting to compare effects of these three intervention types, either applied alone or combined, with each other.…”

Systematic Reviews of the Health or Health care of People with Intellectual Disabilities: A Systematic Review to Identify Gaps in the Evidence Base

“…Ten reviews were concerned with the efficacy of pharmacological interventions in relation to mental and behavioural disorders in people with intellectual disability. These include three Cochrane reviews: pharmacological interventions for self-injurious behaviour (Rana et al 2013) donepezil for Alzheimer's dementia (AD) in people with Down's syndrome (Mohan et al 2009d); and amphetamine for attention-deficit hyperactivity disorder (ADHD) (Thomson et al 2009a). Other reviews considered the following: atypical antipsychotics for behavioural problems in children with intellectual disability or borderline intelligence (Unwin & Deb 2011); clozapine for behavioural problems (Singh et al 2010); melatonin for sleep problems (Braam et al 2009); mood stabilizers and anti-epileptic medication for behavioural problems in adults (Deb et al 2008); pharmacological treatment of bipolar disorder in children and adolescents (Gutkovich & Carlson 2008); pharmacological management of inappropriate sexual behaviours (Sajith et al 2008); and somatic treatment of psychiatric and behavioural problems, including psychotropic medication and electroconvulsive therapy (Ulzen & Powers 2008).…”

“…The majority of these reviews conclude that there is insufficient or poor quality evidence on effectiveness on which to base practice, and therefore a need for further trials. It has been noted that prescribing is based on extrapolation from research in people without intellectual disability (Thomson et al 2009a). The two exceptions to this were the following: 'some evidence' for the use of risperidone to manage behavioural problems in children and adolescents with the caveat that these should be used with caution due to possible adverse events (Unwin & Deb 2011), and results of a meta-analysis indicating that melatonin is effective and safe for treating sleep problems with the caveat that long-term effects are not known and the drug is non-licensed in most countries (Braam et al 2009).…”

Behaviour disorders in children with an intellectual disability

“…The prevalence rate of ADHD in the general population is 5%, (18) and between 9% to 16% in the paediatric population with an ID (19). The long-term impact of ADHD is significant in children with an ID, and can result in anxiety, aggression and social ostracism problems, especially in adolescents (20).…”