Inattention,Hyperactivity,and Impulsivity in Teenagers with Intellectual Disabilities,with and without Autism

Abstract

French

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.

References

Rutter

Graham

Yule

A neuropsychiatric study in childhood. London (UK): Heinemann Medical; 1970.

Epstein

Cullinan

Gadow

. Teacher ratings of hyperactivity in learning-disabled, emotionally-disturbed, and mentally-retarded children. Journal of Special Education 1986;20:219–29.

Epstein

Cullinan

Polloway

. Patterns of maladjustment among mentally retarded children and youth. Am J Ment Defic 1986;91:127–34.

Fox

Wade

. Attention deficit hyperactivity disorder among adults with severe and profound mental retardation. Res Dev Disabil 1998;19:275–80.

Seager

O'Brien

Attention deficit hyperactivity disorder: Review of ADHD in learning disability: The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation [DC-LD] criteria for diagnosis. J Intellect Disabil Res 2003;47 Suppl 1:26–31.

Szatmari

Offord

Boyle

. Ontario Child Health Study: Prevalence of attention deficit disorder with hyperactivity. J Child Psychol Psychiatry 1989;30:219–30.

American Psychiatric Association, American Psychiatric Association Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington (DC): American Psychiatric Association; 2000.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. Geneva (CH): World Health Organization; 1993.

Goldstein

Schwebach

. The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: Results of a retrospective chart review. J Autism Dev Disord 2004;34:329–39.

10.

Statistics Canada. CANSIM. Population by age group. Ottawa (ON): Statistics Canada; 1996.

11.

Bradley

Thompson

Bryson

. Mental retardation in teenagers: Prevalence data from the Niagara region, Ontario. Can J Psychiatry 2002;47:652–9.

12.

Bradley

Bolton

Episodic psychiatric disordrs in teenagers with learning disabilities with and without autism. Br J Psychiatry. Forthcoming.

13.

Wechsler

WAIS-R manual. Wechsler Adult Intelligence Scale, Revised. New York (NY): Harcourt Brace Jovanovich [for] Psychological Corp; 1981.

14.

Wechsler

WISC-R: Wechsler Intelligence Scale for Children, Revised. New York (NY): Psychological Corp; 1974.

15.

Stutsman

Guide for administering the Merrill-Palmer Scale of Mental Tests. New York (NY): Harcourt, Brace & World; 1948.

16.

Sparrow

Balla

Cicchetti

Doll

. Vineland Adaptive Behavior Scales: Survey form manual. Circle Pines (MN): American Guidance Service; 1984.

17.

Lord

Rutter

Le Couteur

Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 1994;24:659–85.

18.

Palisano

Rosenbaum

Walter

Russell

Wood

Galuppi

Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214–23.

19.

Volkmar

Sparrow

Goudreau

Cicchetti

Paul

Cohen

. Social deficits in autism: An operational approach using the Vineland Adaptive Behavior Scales. J Am Acad Child Adolesc Psychiatry 1987;26:156–61.

20.

Loveland

Kelley

. Development of adaptive behavior in adolescents and young adults with autism and Down syndrome. Am J Ment Retard 1988;93:84–92.

21.

Frazier

Biederman

Bellordre

Garfield

Geller

Coffey

Faraone

. Should the diagnosis of attention-deficit/hyperactivity disorder be considered in children with pervasive developmental disorder? J Atten Disord 2001;4:203–11.

22.

Mahoney

. The aggressive and impulsive child: Innovations in assessment and treatment—acommentary. Paediatrics & Child Health 2004;9:537–8.

23.

Brown

. DSM-IV: ADHD and executive function impairments. Advanced Studies in Medicine 2002;2:910–4.

24.

Nordin

Gillberg

Autism spectrum disorders in children with physical or mental disability or both. I: Clinical and epidemiological aspects. Dev Med Child Neurol 1996;38:297–313.