Psych · Intellectual disability psychiatry — neurodevelopmental dual diagnosis
Autism and intellectual disability comorbidity
Also known as ASD with intellectual disability · Autism and ID dual diagnosis · Autism with intellectual developmental disorder · Learning disability and autism · Neurodevelopmental dual diagnosis
Exam-exhaustive fellowship reference on autism spectrum disorder co-occurring with intellectual disability — dual-diagnosis assessment (social communication relative to developmental level), communication and AAC, epilepsy comorbidity, challenging behaviour with positive behaviour support, psychopharmacology for severe irritability with monitoring, capacity, safeguarding and transition. FRANZCP-primary, globally tagged.
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Meet the patient
A 6-year-old boy with established moderate intellectual disability is referred because he has started hitting his mother and banging his head against the wall after mealtimes. He speaks in single words, flaps his hands when excited, and has never been assessed for autism. His mother is exhausted; the GP has written "for risperidone?" at the bottom of the referral.[1][9]
Three questions are now live: is this also autism? what is driving the behaviour? and is an antipsychotic the next step? The fellowship answer to all three lives in the relative-to-developmental-level rule and the medical-behaviour formulation — not in the prescription pad.[1][2][12]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References18Show ledgerHide ledger
- [1]Hyman SL, Levy SE, Myers SM Identification, Evaluation, and Management of Children With Autism Spectrum Disorder Pediatrics, 2020.PMID 31843864
- [2]Thurm A, Farmer C, Salzman E, Lord C, Bishop S State of the Field: Differentiating Intellectual Disability From Autism Spectrum Disorder Front Psychiatry, 2019.PMID 31417436
- [3]Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020 MMWR Surveill Summ, 2023.PMID 36952288
- [4]Zeidan J, Fombonne E, Scorah J, et al. Global prevalence of autism: A systematic review update Autism Res, 2022.PMID 35238171
- [5]Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample J Am Acad Child Adolesc Psychiatry, 2008.PMID 18645422
- [6]Lukmanji S, Manji SA, Kadhim S, et al. The co-occurrence of epilepsy and autism: A systematic review Epilepsy Behav, 2019.PMID 31398688
- [7]Woolfenden S, Sarkozy V, Ridley G, Coory M, Williams K A systematic review of two outcomes in autism spectrum disorder - epilepsy and mortality Dev Med Child Neurol, 2012.PMID 22348343
- [8]Viscidi EW, Johnson AL, Spence SJ, Buka SL, Morrow EM, Triche EW The association between epilepsy and autism symptoms and maladaptive behaviors in children with autism spectrum disorder: a population-based study Autism, 2014.PMID 24165273
- [9]Emerson E, Kiernan C, Alborz A, et al. The prevalence of challenging behaviors: a total population study Res Dev Disabil, 2001.PMID 11263632
- [10]McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems N Engl J Med, 2002.PMID 12151468
- [11]Owen R, Sikich L, Marcus RN, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder Pediatrics, 2009.PMID 19948625
- [12]Tyrer P, Oliver-Africano PC, Ahmed Z, et al. Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial Lancet, 2008.PMID 18177776
- [13]Bearss K, Johnson C, Smith T, et al. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial JAMA, 2015.PMID 25898050
- [14]Fung LK, Mahajan R, Nozzolillo A, et al. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis Pediatrics, 2016.PMID 26908468
- [15]Lord C, Charman T, Havdahl A, et al. The Lancet Commission on the future of care and clinical research in autism Lancet, 2022.PMID 34883054
- [16]Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M; AACAP Committee on Quality Issues Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder J Am Acad Child Adolesc Psychiatry, 2014.PMID 24472258
- [17]Schalock RL, Luckasson R, Tassé MJ An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports (12th ed.) Am J Intellect Dev Disabil, 2021.PMID 34700345
- [18]Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S Premature mortality in autism spectrum disorder Br J Psychiatry, 2016.PMID 26541693