BJP -- eLetters for BRADLEY and BOLTON, 189 (4) 361-366

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PAPERS:
ELSPETH BRADLEY and PATRICK BOLTON
Episodic psychiatric disorders in teenagers with learning disabilities with and without autism
The British Journal of Psychiatry 2006; 189: 361-366 [Abstract] [Full text] [PDF]

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Electronic letters published:

need to do more: Aadil Jan Shah, Ovais Wadoo (19 October 2006)

Diagnostic Enlightenment: Adedamola B Orimalade (8 November 2006)

need to do more 19 October 2006

Aadil Jan Shah,
SHO
Gwent NHS Trust,
Ovais Wadoo
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Re: need to do more

aadilshah{at}gmail.com Aadil Jan Shah, et al.

I was highly impressed by this piece of work done by Elspeth Bradley & Patrick Bolton & I would like to congratulate them.I think this is a topic which was neglected so far. These episodic psychiatric disorders in teenagers & adults with learning disabilities with or without autism could be very challenging. According to my clinical experience so far,to diagnose these episodes in the first instance is very difficult especially in the clients with autism.Even a minor change in their circumstances might trigger these episodes.These individuals are ver sensitive especially with the changes in the staff,changes in the medication or the changes in the environment itself.These changes can lead to aggression,agitation,increase in the frequency of seizures,inappropriate sexual behaviours etc.Individuals who also have diagnosis of depressive or psychotic illness tend to have more of these circumscribed episodes. Lack of definitive psychotic & depressive features makes it hard to diagnose these conditions in this group.Especially problems with the communication & inability to express themselves could be very frustrating both for the individual & the clinician. This present study has also highlightened the use of stimulants in this group (especially individuals with ADHD)which is often neglected. I think this is just a beginning,more research needs to be done on this subject not only in teenage group but also in the adult client group.

Diagnostic Enlightenment 8 November 2006

Adedamola B Orimalade,
Locum Consultant Psychiatrist
Kent and Medway NHS and Social Care Trust.
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Re: Diagnostic Enlightenment

ade.orimalade{at}ekentmht.nhs.uk Adedamola B Orimalade

Bradley et al , investigating the prevalence of ''episodic psychiatric disorders'' in patients with learning disabilities found a prevalence of autism of 23.98% in their sample of 171 teenagers with learning disabilities.
This rate of prevalence of autism in people with learning disabilities is in keeping with other studies and emphasises the importance of having a high index of suspicion for autistic spectrum disorders when managing psychiatric disorders in people with all degrees of learning disabilities. One suspects that the reported prevalence might have been higher if an IQ cut off of 70 (rather than 75) and another tool other than the Autism Diagnostic Interview – Revised (ADI–R), had been used. Deb et al , found 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. Morgan et al , found a prevalence rate of autism of 30% in adults with a learning disability.
This study is another study that shows increased psychiatric co- morbidity in people with learning disability and autism compared to those with learning disabilities without autism (see also Morgan et al, Psychiatric Bulletin, 2003 ). Bradley et al highlight the importance of looking out for autistic spectrum disorders in patients with learning disabilities presenting with axisI psychiatric disorders or indeed all kinds of challenging behaviours. I think it would have been useful to stratify both the sample and results in terms of varying levels of IQ scores, although the authors do report that episodic disorders were not related to gender or to the severity of learning disability.
I agree with the authors that more research is needed to determine why there is an increased prevalence of psychiatric disorders( including major depressive disorders and psychosis) amongst those with learning disabilities and autism, and I thank them for their contribution in casting some light on the notorious diagnostic overshadowing that occurs in learning disabilities.
References:
1. Bradley, E.,Bolton, P. Episodic psychiatric disorders in teenagers with learning disabilities with and without autism Br. J. Psychiatry, Oct 2006; 189: 361 - 366.
2. Lord, C., Rutter, M. & Couteur, A. L. (1994) Autism diagnostic interview – revised. A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659 –685.
3. Deb, S.,Prasad K.P.,The prevalence of autistic disorder among children with a learning disability Br. J. Psychiatry, Sep 1994; 165: 395 - 399.
4. Morgan, C.N.,Roy, M.,Chance, P.,Psychiatric comorbidity and medication use in autism: a community survey Psychiatr. Bull., Oct 2003; 27: 378 - 381.
5. Morgan, C.N.,Roy, M.,Nasr, A.,Chance, P.,Hand, M.,Mlele, T.,Roy, A.,A community survey establishing the prevalence rate of autistic disorder in adults with learning disability Psychiatr. Bull., Apr 2002; 26: 127 - 130.
Dr. Adedamola Orimalade Locum Consultant, Psychiatry of Learning Disabilities, Laurel House, 41 Old Dover Road, Canterbury, Kent. CT1 3HH. Tel; 01227 597123. Fax: 01227 597120.