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Attention Deficit Hyperactivity Disorder in people with Intellectual Disability

  • Bhathika Perera (a1)


Two case reports of people with severe intellectual disability (ID), Autism and challenging behaviour are discussed here to describe the presentation of attention-deficit hyperactivity disorder (ADHD) in people with ID. Both cases highlight how the diagnosis of ADHD can be missed and the behaviours attributed to ID and autism, which could lead to using ineffective treatment strategies. The case reports illustrate the importance of the diagnosis and treatment of ADHD in people with ID and how it can make a difference to their clinical presentation and quality of life.


Corresponding author

*Address for correspondence: Bhathika Perera, Haringey Learning Disability Partnership, River Park House, 225, High Road, London, N22 8HQ, UK. (Email:


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Aman, M, Smith, T, Arnold, L, Corbett-Dick, P, Tumuluru, R, Hollway, J, Hyman, S, Mendoza-Burchamm, M, Pan, X, Mruzek, D, Lecavalier, L, Levato, L, Silverman, L, Handen, B (2014). A review of atomoxetine effects in young people with developmental disabilities. Research in Developmental Disabilities 35, 14121424.
Aman, MG, Buican, B, Arnold, LE (2003). Methylphenidate treatment in children with borderline IQ and mental retardation: analyses of three aggregated studies. Journal of Child and Adolescent Psychopharmacology 13, 2940.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.
Baker, BL, Neece, CL, Fenning, RM, Crnic, KA, Blacher, J (2010). Mental disorders in five-year-old children with or without developmental delay: focus on ADHD. Journal of Clinical Child and Adolescent Psychology 39, 492505.
Banaschewski, T, Coghill, D, Santosh, P, Zuddas, A, Asherson, P, Buitelaar, J, Danckaerts, M, Dopfner, M, Faraone, SV, Rothenberger, A (2006). Long-acting medications for the hyperkinetic disorders, a systematic review and European treatment guideline. European Child Adolescent Psychiatry 15, 476495.
Banaschewski, T, Soutullo, C, Lecendreux, M, Johnson, M, Zuddas, A, Hodgkins, P, Adeyi, B, Squires, L, Coghill, D (2013). Health-related quality of life and functional outcomes from a randomized, controlled study of lisdexamfetamine dimesylate in children and adolescents with attention deficit hyperactivity disorder. CNS Drugs 27, 829.
Biederman, J, Lopez, FA, Boellner, SW (2002). A randomized, double-blind, placebo-controlled, parallel-group study of SLI381 (Adderall XR) in children with attention deficit hyperactivity disorder. Pediatrics 110, 258266.
Courtenay, K, Elstner, S (2016). Drug therapy in ADHD in people with intellectual disabilities. Advances in Mental Health and Intellectual Disabilities 10, 2735.
Craig, F, Margari, F, Legrottaglie, A, Palumbi, R, Giambattista, C, Margari, L (2016). A review of executive function deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment 12, 11911202.
Deb, S, Unwin, G, Deb, T (2015). Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. Journal of Intellectual Disability Research 59, 1125.
Dekker, MC, Koot, HM, Van der Ende, J, Verhulst, FC (2002). Emotional and behavioral problems in children and adolescents with and without intellectual disability. Journal of Child Psychology and Psychiatry 43, 10871098.
Emerson, E (2003). Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. Journal of Intellectual Disability Research 47, 5158.
Emerson, E, Baines, S (2010). The Estimated Prevalence of Autism Among Adults with Learning Disabilities in England. Improving Health and Lives: Stockton-on-Tees.
Fletcher, RJ (2007). DM-ID: Diagnostic Manual—Intellectual Disability: A Clinical Guide for Diagnosis of Mental Disorders in Persons With Intellectual Disability. National Association for the Dually Diagnosed: Kingston, NY.
Ginsberg, Y, Quintero, J, Anand, E, Casiilas, M, Upadhyaya, P (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Primary Care Companion for CNS Disorder 16(3), PCC.13r01600.
Greenhill, LL, Swanson, J, Vitiello, B, Davies, M, Clevenger, W, Wu, M, Arnold, LE, Abikoff, HB, Bukstein, OB, Conners, CK, Elliott, GR, Hechtman, L, Hinshaw, SP, Hoza, B, Jensen, PS, Kraemer, HC, March, JS, Newcorn, JH, Severe, JB, Wells, K, Wigal, T (2001). Impairment and deportment responses to different Methylphenidate doses in children with ADHD: the MTA titration trial. Journal of the American Academy of Child & Adolescent Psychiatry 40, 180187.
Ji, NJ, Findling, RL (2016). Pharmacotherapy for mental health problems in people with intellectual disability. Current Opinion in Psychiatry 29, 103125.
Kooij, SJ, Bejerot, S, Blackwell, A (2010). European consensus statement on diagnosis and treatment of adult ADHD: the European Network Adult ADHD. BMC Psychiatry 10, 67.
Leucht, S, Pitschel-Walz, G, Abraham, D, Kissling, W (1999). Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 35, 5168.
Matson, J, Mahan, S (2010). Antipsychotic drug side effects for persons with intellectual disability. Research in Developmental Disabilities 31, 15701576.
Mayes, SD, Calhoun, SL, Mayes, RD, Molitoris, S (2012). Autism and ADHD: overlapping and discriminating symptoms. Research in Autism Spectrum Disorders 6, 277285.
Melnyk, L, Das, JP (1992). Measurement of attention deficit: correspondence between rating scales and tests of sustained and selective attention. American Journal of Mental retardation 96, 599606.
Michelson, D, Adler, L, Spencer, T, Reimherr, FW, West, SA, Allen, AJ, Kelsey, D, Wernicke, J, Dietrich, A, Milton, D (2003). Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biological Psychiatry 53, 112120.
Michelson, D, Faries, D, Wernicke, J, Kelsey, D, Kendrick, K, Sallee, FR, Spencer, T; Atomoxetine ADHD Study Group (2001). Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics 108, E83.
Myers, CS (1915). A contribution to the study of the shell shock. Being an account of three cases of loss of memory, vision, smell and taste, admitted into the Duchess of Westminster’s War Hospital, Le Touquet. Lancet 185, 316320.
Neece, CL, Baker, BL, Blacher, J, Crnic, KA (2011). Attention-deficit/hyperactivity disorder among children with and without intellectual disability: an examination across time. Journal of Intellectual Disability 55, 623635.
Neece, CL, Baker, BL, Crnic, K, Blacher, J (2013). Examining the validity of ADHD as a ‘diagnosis for adolescents with intellectual disabilities: clinical presentation’. Journal of Abnormal Child Psychology 41, 597612.
National Institute for Health and Clinical Excellence (NICE) (2008). Attention deficit hyperactivity disorder: diagnosis and management (CG72), NICE. London.
Pearson, DA, Lachar, D, Loveland, KA, Santos, CW, Faria, LP, Azzam, PN, Hentges, BA, Cleveland, LA (2000). Patterns of behavioral adjustment and maladjustment in mental retardation: comparison of children with and without ADHD. American Journal of Mental Retardation 105, 236251.
Pettersson, R, Söderström, S, Nilsson, KW (2015). Diagnosing ADHD in adults: an examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. Journal of Attention Disorder. Advance online publication. doi:10.1177/1087054715618788.
Polanczyk, G, Silva de Lima, M, Horta, L, Biederman, J, Rohde, L (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942948.
Ramos-Quiroga, JA, Nasillo, V, Richarte, V, Corrales, M, Palma, F, Ibáñez, P, Michelsen, M, Van de Glind, G, Casas, M, Kooij, JJ (2016). Criteria and concurrent validity of DIVA 2.0: a semi-structured diagnostic interview for adult ADHD. Journal of Attention Disorders, pii: 1087054716646451.
Rugino, TA, Copley, TC (2001). Effects of modafinil in children with attention-deficit/hyperactivity disorder: an open-label study. Journal of the American Academy of Child & Adolescent Psychiatry 40, 230235.
Sallee, FR, Lyne., A, Wigal, T, McGough, JJ (2009). Long-term safety and efficacy of guanfacine extended release in children and adolescents with attention deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology 19, 215226.
Sheehan, R, Hassiotis, A, Walters, K, Osborn, D, Strydom, A, Horsfall, L (2015). Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. British Medical Journal 351, h4326.
Simonoff, E, Pickles, A, Charman, T, Chandler, S, Loucas, T (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry 47, 921929.
Spencer, T, Biederman, J, Wilens, T (2000). Pharmacotherapy of attention deficit hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America 9, 7797.
Voigt, RG, Barbaresi, WJ, Colligan, RC, Weaver, AL, Katusic, SK (2006). Developmental dissociation, deviance, and delay: occurrence of attention deficit hyperactivity disorder in individuals with and without borderline to mild intellectual disability. Developmental Medicine and Child Neurology 48, 831835.
Wolraich, M, Greenhill, LL, Pelham, W, Swanson, J, Wilens, T, Palumbo, D, Atkins, M, McBurnett, K, Bukstein, O, August, G (2001). Randomized controlled trial of OROS methylphenidate in children with attention deficit/hyperactivity disorder. Pediatrics 108, 883892.


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Attention Deficit Hyperactivity Disorder in people with Intellectual Disability

  • Bhathika Perera (a1)


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