Elspeth Bradley

Comparing Rates of Psychiatric and Behavior Disorders in Adolescents and Young Adults with Severe Intellectual Disability with and without Autism.

Eight males and four females with an Autism Diagnostic Interview-Revised (ADI-R) diagnosis of autism (mean age of 16.3 years) and severe intellectual disability (IQ < 40) were individually matched to controls on the basis of chronological age, gender, and nonverbal IQ. The dependent measure was the Diagnostic Assessment for the Severely Handicapped-II, which is used to screen for psychiatric and behavior disorders in lower-functioning individuals. Participants with autism showed significantly greater disturbances as measured by the Diagnostic Assessment for the Severely Handicapped-II total score and seven of 13 subscales. They also averaged 5.25 clinically significant disturbances compared with 1.25 disturbances for participants without autism. Specific vulnerabilities to anxiety, mood, sleep, organic syndromes, and stereotypies/tics were found in the participants with comorbid autism.

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities.

Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indications in this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come and adverse effects, follow-up arrangements, and possibility of discontinuation of treatment.

Inattention, Hyperactivity, and Impulsivity in Teenagers With Intellectual Disabilities, With and Without Autism

Objective: To explore inattentive, hyperactive, and impulsive behaviours in teenagers with intellectual disabilities (ID), with and without autism. Method: We identified teenagers with ID, with and without autism, in a single geographic area. Those with autism were matched for age, sex, and nonverbal IQ to those with ID only. We compared inattentive, hyperactive, and impulsive (IHI) behaviours in the 2 groups, along with adaptive functioning and medical circumstances. We further subdivided the autism group into those with IHI behaviours (autism IHI) and those without (autism non-IHI) and explored similarities and differences between autism subgroups. Results: As a group, those with autism and ID had more IHI behaviours than those with ID alone. More in the autism group met criteria for attention-deficit hyperactivity disorder and hyperkinetic syndrome. Lifetime exposure to psychotropic medication was greater in the autism group, with stimulant and antipsychotic medications predominating. However, just under one-half of those in the autism group showed no IHI behaviours. Comparison of autism IHI and autism non-IHI groups showed that those with IHI behaviours were significantly more likely to have past (but not current) exposure to stimulant medication. Conclusions: One in 2 teenagers with ID and coexisting autism displayed clinically significant inattentive, hyperactive, and (or) impulsive behaviours, compared with 1 in 7 of those with ID alone. Most of the remaining teenagers with autism displayed no IHI behaviours. Our results support the need for further investigation into the prevalence and etiology of these IHI behaviours in individuals with autism.

A Comparison of Patients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals.

BACKGROUND Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more specialised programmes. This study compares patients with ID receiving specialised services to patients with ID receiving general services in Ontarios tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources and clinical service needs. METHOD A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for all 371 inpatients with ID, from both specialised and general programmes. RESULTS Inpatients in specialised programmes were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than those in more general programmes. The two groups did not differ significantly in terms of recommended level of care, although more inpatients from specialised programmes were rated as requiring Level 4 care than inpatients from general programmes. CONCLUSIONS In Ontario, inpatients in specialised and general programmes have similar overall levels of need but unique clinical profiles that should be taken into consideration when designing interventions for them.

Senior residents in psychiatry: Views on training in developmental disabilities

Objectives: To determine the proportion of senior residents who believed their education in the field of developmental disabilities was adequate and to collect suggestions for improvements. Method: We distributed a self-administered questionnaire to senior residents prior to an annual voluntary preparatory exam. Their views on training in developmental disabilities and ideas about improving curricula were solicited in detail, and their feedback results were analyzed. Results: Of the 89 senior residents who attended the exam, 60 (67.4%) completed the survey. This represents 29% of the national complement. Most (85%) of the one-half who reported receiving undergraduate training in developmental disabilities felt the quantity was inadequate. Almost 90% of those who did not receive training felt they should have. Of respondents, 85% received residency training in dual diagnosis, but most (59%) felt more curriculum time was needed. Conclusions: Senior residents also desire curricular enhancements that experts in developmental disabilities have long recommended.

Gender Differences in Psychiatric Diagnoses Among Inpatients With And Without Intellectual Disabilities

There are few published studies on the relationship between gender and psychiatric disorders in individuals with intellectual disabilities. Adults (N = 1,971) with and without intellectual disabilities who received inpatient services for psychiatric diagnosis and clinical issues were examined. Among individuals with intellectual disabilities, women were more likely to have a diagnosis of mood disorder and sexual abuse history; men were more likely to have a substance abuse diagnosis, legal issues, and past destructive behavior. Gender difference patterns found for individuals with intellectual disabilities were similar to those of persons without intellectual disabilities, with the exception of eating disorder and psychotic disorder diagnoses. Gender issues should receive greater attention in intellectual disabilities inpatient care.

Psychiatric conditions and behavioural problems in adolescents with intellectual disabilities: correlates with autism.

Objective: To determine whether psychiatric and behavioural disorders occur more frequently in adolescents with autism and intellectual disabilities, compared with those without autism. Method: A population-based case–control study was undertaken and 36 adolescents with autism were pairwise matched for age and IQ to 36 adolescents without autism. Caregivers were interviewed with structured psychiatric interview and questionnaire measures of psychiatric and behavioural problems. Results: Compulsive behaviours and stereotypies were significantly more common in adolescents with autism. Conclusions: Adolescents with autism are prone to compulsive behaviours and stereotypies as well as specific manifestations of anxiety, fears, and phobias.

Recognition of intellectual disabilities and autism in psychiatric inpatients diagnosed with schizophrenia and other psychotic disorders

Purpose – The purpose of this paper is to determine: the extent to which an intellectual disability diagnosis meets current diagnostic and statistical manual of mental disorders (DSM) diagnostic criteria; the prevalence of reported autism spectrum disorders (ASD); and the extent to which assessment of developmental issues is central to the diagnosis of psychotic disorder, in patients discharged with a diagnosis of psychotic disorder and intellectual disabilities.Design/methodology/approach – Of all patients discharged with psychotic disorder during a four‐year period (n=3339), chart reviews were completed on those also diagnosed with intellectual disability or borderline IQ.Findings – The findings if this paper are threefold: only 39 percent of the 41 individuals discharged with a diagnosis of psychotic disorder and intellectual disability met documented DSM criteria for intellectual disability; the prevalence of reported ASD was much lower than expected; and the average number of different discharge diag...

The diagnostic boundary between autism spectrum disorder, intellectual developmental disorder and schizophrenia spectrum disorders

Purpose – During the last few years the prevalence of autism and Autism Spectrum Disorder (ASD) has increased greatly. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. The purpose of this paper is to define the boundaries and overlapping clinical characteristics of IDD, ASD and SSD; highlight the most relevant differences in clinical presentation; and provide a clinical framework within which to recognize the impact of IDD and ASD in the diagnosis of SSD. Design/methodology/approach – A systematic mapping of the international literature was conducted on the basis of the following questions: first, what are considered to be core and overlapping aspects of IDD, ASD and SSD; second, what are the main issues in clinical practice; and third, can key diagnostic flags be identified to assist ...

A comparison of outpatients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals: A comparison of outpatients

BACKGROUND This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontarios tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. METHODS A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes. RESULTS Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care. CONCLUSIONS Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.