Intellectual Disability and Attention-Deficit/Hyperactivity Disorder: What Does the Clinical and Genetic Overlap Mean for Practice and Research?

Thapar, Anita

doi:10.1016/j.jaac.2016.11.012

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Moreover, comorbidity can result in diagnostic overshadowing, whereby all clinical symptoms are attributed to a primary diagnosis rather than to additional comorbidity. This occurs particularly in cases of ID [ 37 ], and can impede diagnosis of other treatable conditions. CNV carriers are also likely to experience clinically impairing symptoms which do not fit traditional categorical diagnoses, and clinicians should consider dimensional and functional domains of impairment such as attention, social functioning, affect and executive functioning [ 38 ] rather than focussing solely on categorical diagnostic criteria.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Clinical evaluation of patients with a neuropsychiatric risk copy number variant

Chawner

2021

Current Opinion in Genetics & Development

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Several copy number variants (CNVs) have been identified to confer high risk for a range of neuropsychiatric conditions. Because of advances in genetic testing within clinical settings, patients are increasingly receiving diagnoses of copy number variant genomic disorders. However, clinical guidelines surrounding assessment and management are limited. This review synthesises recent research and makes preliminary recommendations regarding the clinical evaluation of patients with neuropsychiatric risk CNVs. We recommend multi-system assessment beyond the initial referral reason, recognition of the potential need for co-ordinated multidisciplinary care, and that interventions take account of relevant multimorbidity. The frequently complex needs of patients with CNVs across the life-course pose challenges for many health care systems and may be best provided for by the establishment of specialist clinics.

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Section: Clinical Evaluationmentioning

confidence: 99%

Clinical evaluation of patients with a neuropsychiatric risk copy number variant

Chawner

2021

Current Opinion in Genetics & Development

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“…Moreover, diagnostic assessment of ADHD in individuals with severe ID is particularly challenging (Thapar 2017;Oliver et al 2020). More co-ordinated research, involving larger samples and using comparable measures, is needed further to explore potential relationships between sleeping problems and behaviour in AS.…”

Section: Sdq Total Difficultiesmentioning

confidence: 99%

Hyperactive behaviour in Angelman syndrome: the association with sleep problems and age of epilepsy onset

Bakke

Howlin

Helverschou

2021

J intellect Disabil Res

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Background Sleep problems are common in many neurodevelopmental disorders, but little is known about how sleep is related to behavioural symptoms in Angelman syndrome (AS) or other genetic disorders. Hyperactive behaviour, sleep problems and epilepsy seem to be more common in AS than in other genetic conditions associated with severe intellectual disability. We hypothesised that both more sleep problems and earlier onset of epileptic seizures would predict more symptoms of hyperactivity. Hence, the aim of the project was to explore the association between hyperactive behaviour, sleep problems and age of epilepsy onset in individuals with AS. Method All known parents/guardians (n = 115) of individuals with AS in Norway were invited to participate in this descriptive correlational study. Fifty-six individuals (49%) responded, and 42 people (25 male and 17 female; mean age 18.5 years, range 2-57 years) with genetically verified AS were included. Scores for 'hyperactivity' and 'sleep problems' were derived from questionnaire data. Information on epilepsy was obtained from medical records. Results 'Hyperactivity' was positively correlated with 'total sleep problems' (r = 0.46, P = 0.002) and negatively correlated with 'age of epilepsy onset' (r = À0.47, P = 0.01). 'Age of epilepsy onset' was not correlated with 'total sleep problems'. An overall multiple regression model with 'hyperactivity' as the dependent variable and 'age of epilepsy onset' and 'total sleep problems' as covariates was significant (R 2 = 0.39, F = 8.16, P = 0.002). Hence, hyperactivity in AS could be predicted from both age of epilepsy onset and current sleep problems. Conclusions Sleep problems may increase hyperactivity symptoms in individuals with AS. The association between hyperactivity and sleep problems in AS indicates that both should be investigated together as part of routine clinical assessment and intervention for either area of difficulty. Younger age of epilepsy onset was associated with more hyperactivity in AS, which may be related to encephalopathic effects of seizures and epilepsy.

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“…The point prevalence of ADHD in adults in the general population has been estimated at around 2.5% (Faraone et al, 2021;Fayyad et al, 2017). The corresponding prevalence in adults with intellectual disability is generally accepted to be significantly higher (Thapar, 2017) but has been difficult to accurately define owing to differences in methodological approaches, case ascertainment, and sampling frames (Reilly & Holland, 2011). Studies have estimated that ADHD may be present in up to 20% of adults with intellectual disability (La Malfa, Lassi, Bertelli, Pallanti, & Albertini, 2008) and may be even more prevalent in people with certain genetic conditions associated with intellectual disability, including Down syndrome and Fragile X syndrome (Lo-Castro, D'Agati, & Curatolo, 2011).…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and pharmacological management of attention deficit hyperactivity disorder in adults with and without intellectual disability: cohort study using electronic health records

Sheehan,

Leng,

Woods

et al. 2024

Psychol. Med.

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Background Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. People with intellectual disability have higher rates of ADHD yet there is little evidence on the presentation and pharmacological treatment of ADHD in this population or how this differs from the general population. Methods Retrospective cohort study using data from electronic health records. Adults with intellectual disability newly diagnosed with ADHD between 2007 and 2022 were matched to adults with ADHD without intellectual disability and their clinical features and treatments were compared. Results A total of 159 adults with ADHD and intellectual disability and 648 adults with ADHD without intellectual disability formed the dataset. Adults with intellectual disability had higher rates of psychiatric co-morbidity and spent more time under mental health services than those without intellectual disability. They were more likely to have recorded agitation, aggression, hostility, and mood instability, and less likely to have poor concentration recorded in the 12 months prior to the diagnosis of ADHD. Following diagnosis, people with intellectual disability were significantly less likely to be prescribed any medication for ADHD than controls without intellectual disability (adjusted odds ratio 0.60, 95% confidence interval 0.38–0.91), and were less likely to be prescribed stimulants (27.7% v 46.0%, p < 0.001). Conclusions The presence of behaviors that challenge in adults with intellectual disability may indicate co-occurring ADHD. Further work to define the safety and efficacy of medication for ADHD in adults with intellectual disability is needed to understand differences in prescription rates and to avoid inequities in care outcomes.

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Intellectual Disability and Attention-Deficit/Hyperactivity Disorder: What Does the Clinical and Genetic Overlap Mean for Practice and Research?

Abstract: . Intellectual disability and attention-deficit/hyperactivity disorder: What does the clinical and genetic overlap mean for practice and research?

Cited by 8 publications

References 10 publications

Clinical evaluation of patients with a neuropsychiatric risk copy number variant

Clinical evaluation of patients with a neuropsychiatric risk copy number variant

Hyperactive behaviour in Angelman syndrome: the association with sleep problems and age of epilepsy onset

Diagnosis and pharmacological management of attention deficit hyperactivity disorder in adults with and without intellectual disability: cohort study using electronic health records

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