Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool
Background Attention-deficit hyperactivity disorder (ADHD) is common among people with intellectual disability. Diagnosing ADHD in this clinically and cognitively complex and diverse group is difficult, given the overlapping psychiatric and behavioural presentations. Underdiagnoses and misdiagnoses...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2021-11-01
|
| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472421010231/type/journal_article |
| _version_ | 1811156944728096768 |
|---|---|
| author | Indermeet Sawhney Bhathika Perera Paul Bassett Asif Zia Regi T Alexander Rohit Shankar |
| author_facet | Indermeet Sawhney Bhathika Perera Paul Bassett Asif Zia Regi T Alexander Rohit Shankar |
| author_sort | Indermeet Sawhney |
| collection | DOAJ |
| description |
Background
Attention-deficit hyperactivity disorder (ADHD) is common among people with intellectual disability. Diagnosing ADHD in this clinically and cognitively complex and diverse group is difficult, given the overlapping psychiatric and behavioural presentations. Underdiagnoses and misdiagnoses leading to irrational polypharmacy and worse health and social outcomes are common. Diagnostic interviews exist, but are cumbersome and not in regular clinical use.
Aims
We aimed to develop a screening tool to help identify people with intellectual disability and ADHD.
Method
A prospective cross-sectional study, using STROBE guidance, invited all carers of people with intellectual disability aged 18–50 years open to the review of the psychiatric team in a single UK intellectual disability service (catchment population: 150 000). A ten-item questionnaire based on the DSM-V ADHD criteria was circulated. All respondents’ baseline clinical characteristics were recorded, and the DIVA-5-ID was administered blinded to the individual questionnaire result. Fisher exact and multiple logistic regressions were conducted to identify relevant questionnaire items and the combinations that afforded best sensitivity and specificity for predicting ADHD.
Results
Of 78 people invited, 39 responded (26 men, 13 women), of whom 30 had moderate-to-profound intellectual disability and 38 had associated comorbidities and on were medication, including 22 on psychotropics. Thirty-six screened positive for ADHD, and 24 were diagnosed (16 men, eight women). Analysis showed two positive responses on three specific questions to have 88% sensitivity and 87% specificity, and be the best predictor of ADHD.
Conclusions
The three-question screening is an important development for identifying ADHD in people with intellectual disability. It needs larger-scale replication to generate generalisable results.
|
| first_indexed | 2024-04-10T04:59:30Z |
| format | Article |
| id | doaj.art-be484f68519145578395199a4809143c |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:59:30Z |
| publishDate | 2021-11-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-be484f68519145578395199a4809143c2023-03-09T12:29:17ZengCambridge University PressBJPsych Open2056-47242021-11-01710.1192/bjo.2021.1023Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening toolIndermeet Sawhney0Bhathika Perera1https://orcid.org/0000-0001-9316-9312Paul Bassett2Asif Zia3Regi T Alexander4https://orcid.org/0000-0003-0710-6177Rohit Shankar5https://orcid.org/0000-0002-1183-6933Adult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UKAdult learning disability services, Barnet Enfield and Haringey Mental Health NHS Trust, UKStatsconsultancy Ltd., UKAdult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UKAdult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UKAdult learning disabilities service, Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Medical School, UK Background Attention-deficit hyperactivity disorder (ADHD) is common among people with intellectual disability. Diagnosing ADHD in this clinically and cognitively complex and diverse group is difficult, given the overlapping psychiatric and behavioural presentations. Underdiagnoses and misdiagnoses leading to irrational polypharmacy and worse health and social outcomes are common. Diagnostic interviews exist, but are cumbersome and not in regular clinical use. Aims We aimed to develop a screening tool to help identify people with intellectual disability and ADHD. Method A prospective cross-sectional study, using STROBE guidance, invited all carers of people with intellectual disability aged 18–50 years open to the review of the psychiatric team in a single UK intellectual disability service (catchment population: 150 000). A ten-item questionnaire based on the DSM-V ADHD criteria was circulated. All respondents’ baseline clinical characteristics were recorded, and the DIVA-5-ID was administered blinded to the individual questionnaire result. Fisher exact and multiple logistic regressions were conducted to identify relevant questionnaire items and the combinations that afforded best sensitivity and specificity for predicting ADHD. Results Of 78 people invited, 39 responded (26 men, 13 women), of whom 30 had moderate-to-profound intellectual disability and 38 had associated comorbidities and on were medication, including 22 on psychotropics. Thirty-six screened positive for ADHD, and 24 were diagnosed (16 men, eight women). Analysis showed two positive responses on three specific questions to have 88% sensitivity and 87% specificity, and be the best predictor of ADHD. Conclusions The three-question screening is an important development for identifying ADHD in people with intellectual disability. It needs larger-scale replication to generate generalisable results. https://www.cambridge.org/core/product/identifier/S2056472421010231/type/journal_articleAttention-deficit hyperactivity disorderscomorbiditydevelopmental disordersintellectual disabilitystatistical methodology |
| spellingShingle | Indermeet Sawhney Bhathika Perera Paul Bassett Asif Zia Regi T Alexander Rohit Shankar Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool BJPsych Open Attention-deficit hyperactivity disorders comorbidity developmental disorders intellectual disability statistical methodology |
| title | Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool |
| title_full | Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool |
| title_fullStr | Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool |
| title_full_unstemmed | Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool |
| title_short | Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool |
| title_sort | attention deficit hyperactivity disorder in people with intellectual disability statistical approach to developing a bespoke screening tool |
| topic | Attention-deficit hyperactivity disorders comorbidity developmental disorders intellectual disability statistical methodology |
| url | https://www.cambridge.org/core/product/identifier/S2056472421010231/type/journal_article |
| work_keys_str_mv | AT indermeetsawhney attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool AT bhathikaperera attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool AT paulbassett attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool AT asifzia attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool AT regitalexander attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool AT rohitshankar attentiondeficithyperactivitydisorderinpeoplewithintellectualdisabilitystatisticalapproachtodevelopingabespokescreeningtool |