Patterns of comorbidity and psychopharmacology in adults with intellectual disability and attention deficit hyperactivity disorder: an UK national cross-sectional audit

ABSTRACT

Background: Attention-deficit hyperactivity disorder (ADHD) is higher in people with intellectual disability (ID) compared to the general population. Available limited evidence suggests this population has increased psychological problems, diagnostic overshadowing and psychotropic prescribing. This audit Identifies and analyzes real-world characteristics, diagnostic practices, treatment, and management of ADHD in adults with ID.

Research Design and Methods: Pooled retrospective case note data for people with ID and ADHD, collected from 30 organizations across the UK, were analyzed. Patients were classified into mild and moderate-profound ID groups. Associated mental health and neurodevelopmental co-morbidity, Demographics, concomitant psychotropics, and mental and behavioral concerns were collected. Group differences were reported using logistic regression models.

Results: Of 445 participants, 73% had co-occurring autism spectrum disorder (ASD) and 65% were prescribed ADHD medications. Those on ADHD medication were less likely to be prescribed antipsychotics (p < 0.001) and antidepressants (p < 0.001). Multiple significant differences were found in ADHD medication response between ID groups and those with/without co-morbid ASD but not associated with challenging behavior reduction.

Conclusions: High levels of neurodevelopmental and psychiatric comorbidity were found. ID severity and the presence of ASD appear to influence the use of certain psychotropic medications. Appropriate use of ADHD medication appears to reduce psychotropic polypharmacy.

KEYWORDS:

• Intellectual disability
• ADHD
• autism spectrum disorder
• antipsychotics
• antidepressants
• stomp

Acknowledgments

The study was coordinated by the ADHD in ID Peer Group, of the Neurodevelopmental Psychiatry Special Interest Group, of the Royal College of Psychiatrists, UK. Data were collected by the National ADHD in ID Audit Collaboration. List of collaborators (in alphabetical order): Sayed Ahmed, Alaa Al-Dabbagh, Bijil Arackal, Hannah Aslam, Susan Baker, Kanmani Balaji, Clare Bridger, Rebecca Brown, Aamina Cheema, Yaseen Daudjee, Ravi De Silva, Jennifer Dolman, Harry Dudson, Rosie England, Fahima Hakim, Shakeel Islam, Neeraj Joshi, Chaya Kapugama, Peter Langdon, Amanda McGowan, Penelope McKenna, Kamalika Mukherji, Sanjay Nelson, Stacey Oliver-Singleton, Swapnil Palod, Shama Parveen, Rani Pathania, Suraj Perera, Natalia Perez-Achiaga, Amina Rawat, Kristian Roberts, Owen Roberts, Indermeet Sawhney, Claire Smith, Mike Smith, Ross Spackman, Shyamala Thalayasingam, Dave Way, Anusha Wijeratne, and Soe Win.

Declaration of interest

B Perera has received conference speaker fees from Flynn Pharma and Janssen Pharmaceuticals on the subject matter addressed in this manuscript. R Shankar has received institutional and research support as well as personal fees from LivaNova, UCB Pharma, Eisai, Veriton Pharma, Bial and Desitin, all outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

BP, JC, LK, AB, KC, St, WH and RS conceptualized, analyzed, designed, and wrote up the study. All authors contributed significantly. All authors are in agreement to be accountable for all aspects of the work.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript has not been funded.