Autism and intellectual disability dual diagnosis — structured clinical viva

Can he have both? Yes. Dual coding of ASD and ID is allowed when both criteria are met. The hinge is that social communication is below that expected for developmental level, with RRBs and early onset — not IQ alone and not automatic dual labels.^[1][2]

Assessment and communication. Developmental history, adaptive and cognitive assessment, multi-setting social-communication observation relative to mental age, RRB/sensory profile, collateral, structured tools as aids. Communication: audiology pathway, speech-language input, total communication, AAC immediately if speech is limited. Genetics after ASD diagnosis when indicated (microarray, fragile X).^[1][2]

Epilepsy. Co-occurrence of epilepsy and autism is common and higher with ID. Possible absences need seizure history, neurology liaison, EEG when indicated; behaviour may be peri-ictal. Do not treat all stereotypy as seizure.^[3]

Challenging behaviour stepped plan. Safety → medical pain screen → functional analysis/PBS → communication/AAC and environmental supports → treat epilepsy/mental health comorbidities → only then consider risperidone (RUPP: low start ~0.25–0.5 mg/day weight-based, metabolic/EPS/prolactin monitoring) or aripiprazole (Owen: often 2 mg start; metabolic/akathisia monitoring) for severe irritability. Name Tyrer 2008: antipsychotics not superior to placebo for aggression in adults with ID — population-specific prescribing.^[4][5][6][7]

Name evidence. Hyman; Thurm; Lukmanji; McCracken RUPP; Owen; Tyrer; Emerson.^{[1][2][3][4][5][6][7]}