Sleep disorders in children and adolescents with learning disabilities and their management

Differences in the Psychopharmacological Trajectories of School-Age Children with Attention-Deficit/Hyperactivity Disorder with and without Intellectual Disability

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) affects 5% - 7% of school-aged children, while intellectual disability (IDD) affects approximately 1% of the general population. Diagnosing and treating ADHD in individuals with IDD is challenging, not only due to communication difficulties but also because of psychiatric comorbidities that may be present. These factors can result in underdiagnosis of ADHD and increased prescribing of other psychotropic medications. The aim of this study was to determine differences in psychopharmacological treatment (number of prescribed psychostimulants, inefficacy, adverse effects) and in the number of comorbidities and other prescribed psychotropic drugs between patients with ADHD, with and without ID.

METHODS

In the study, 845 children were included, divided into two groups: 574 with ADHD without ID and 271 with ADHD with ID. Microsoft® Excel® was used to calculate the Student's t-test, and statistical significance was assumed using the standard p-value of < 0.05.

RESULTS

No significant differences were found in the average number of psychostimulants prescribed between groups (p = 0.57). Among those with ADHD without ID, 52.4% switched psychostimulants, while in the group with ADHD and ID, this change occurred in 56.1%. Statistically significant differences were found in the average number of other psychotropic medications prescribed per patient (p < 0.05) and in the number of antipsychotics prescribed (p < 0.05). Although our study showed more antipsychotic prescriptions for patients with ID compared to those without ID, some studies report similar use of antipsychotics between these groups. Additionally, the group with ID presented significantly more comorbidities than the group without ID (p < 0.05). These findings are aligned with the literature, which indicates a higher prevalence of psychiatric comorbidities in samples of patients with ID compared to those without ID (50% vs 18%).

CONCLUSION

Individuals with ID are diagnosed with more psychiatric comorbidities and are prescribed more psychotropic drugs. Additionally, more adverse effects and inefficacy with psychostimulants in ID populations require careful monitoring after initiation.

Sleep apnea in people with Down syndrome: Causes and effects of physical activity?

Poor sleep quality is recognized as a major risk factor for poor health, increasing the incidence of serious chronic diseases. In people with Down syndrome, sleep apnea prevalence is significantly greater, it is caused by genetic, anatomical, endocrine, and metabolic abnormalities. The consequences of sleep disruption due to sleep apnea are very serious, especially in terms of neurocognitive and cardiovascular effects, leading to reduced life expectancy and quality of life in this population. However, the management, care, and treatment of related disorders in people with Down syndrome are still inadequate and limited. Therefore, this article wants to increase understanding and awareness about sleep apnea and the benefits of physical activity in improving sleep quality in the Down syndrome community, families, and their care specialists.

The association between internet addiction, sleep quality, and health-related quality of life among Iranian medical students

Due to the increasing use of the internet in Iranian society, especially among students, and the importance of sleep quality (SQ) and quality of life (QOL), the present study examined the relationship between QOL, SQ, and internet addiction (IA) among medical science students. In the present descriptive-analytical study, the sample comprised Saveh University of Medical Sciences students who were studying in 2019. The survey included demographic information (i.e., age, gender, place of residence, field of study, semester, marital status, smoking status, daily exercise) and the 20-item Internet Addiction Test. From 285 distributed questionnaires, 279 individuals with a mean age of 21.01 years (SD ± 3.17) completed the survey. Findings indicated that students with IA had higher mean scores on (i) all physical dimensions concerning QOL (except for the physical pain) and (ii) all psychological dimensions of QOL. The findings will help national health authorities and planners in Iran design appropriate and effective interventions to improve student health and prevent IA.

Influence of Age, Gender, and Living Circumstances on Patterns of Attention-Deficit/Hyperactivity Disorder Medication Use in Children and Adolescents With or Without Intellectual Disabilities

AIMS AND OBJECTIVES

The aim of the study was to determine whether there are differences in psychopharmacological practice for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents dependent on the presence or absence of associated intellectual disability; and if there are, whether the differences are influenced by factors such as age, gender, and living circumstances.

METHODOLOGY

A case-control cross-sectional design was used. Each arm of the study had a total of 107 children and adolescents aged 5-18 years. Case participants had diagnoses of having intellectual disability and ADHD; comparison participants had diagnoses of having ADHD, but no intellectual disability. Outcome measurements were (1) concurrent use of medications-single medication event as against concurrent multiple medication events-and (2) type of medication used-stimulants versus nonstimulants. Demographic factors considered were gender, age, and living circumstances.

RESULTS

Male-to-female ratio in each group was 90:17. Mean age in the case group was 10.93 years (standard deviation [SD]: 3.39 years) and in the comparison group, 12.34 years (SD: 3.22 years). Seventy percent of the case group lived with their biological families, while 84% of the comparison group did so. In the case group, 7.5% were in residential school placements compared with only 0.9% of the comparison group. There were no statistically significant differences in broad measurements of outcomes between the case and comparison groups. Age appeared to be an important moderating factor for type of medication prescribed. Younger children with intellectual disabilities and ADHD were more likely to be established on nonstimulant medications than those with ADHD and no intellectual disabilities (p = 0.024, odds ratio: 1.8; 95% CI: 1.2-2.7).

CONCLUSIONS

Being between the ages of 5 and 12 years and having intellectual disability and ADHD are associated with raised likelihood of being prescribed nonstimulant medications for ADHD. This difference is maintained irrespective of gender and living circumstances. Reasons for these differences in prescribing practice require further exploration.

Innovations in Practice: 'Off-label' clonidine: UK Paediatric and Child and Adolescent Psychiatry prescribing practice for sleep problems

BACKGROUND

Psychopharmacological prescribing of clonidine has been described in Australia and in the United States but not in Europe. This study explores UK clinician experience of clonidine 'off label' in treating paediatric sleep problems in the context of a paucity of evidence for its use.

METHODS

Survey of UK Child and Adolescent Psychiatrists (CAPs) and specialist Paediatricians.

RESULTS

Of 389 respondents (30% Paediatricians, 70% CAPs), 172 prescribed clonidine and 85 having used it for treating sleep. Treatment targets were sleep onset, night waking and nonspecific sleep problems, and carer respite, in patients with significant coexisting neurological and neurodevelopmental disorders. Most used clonidine as a second line medication after trying nonpharmacological approaches. The majority reported initial effectiveness, and adverse effects were mild or transient. Issues of reducing long-term effectiveness, drug tolerance and considerable differences in dosing regimes were identified.

CONCLUSIONS

Clonidine use appears less widespread in the United Kingdom than reported elsewhere. It is seen as a potentially effective and safe intervention but this study highlights the need for good quality RCT evidence for the most effective use of clonidine in paediatric sleep disorders.

Fragile X syndrome: lifespan developmental implications for those without as well as with intellectual disability

PURPOSE OF REVIEW

Advances in developmental neuropsychiatry and the mental health needs of people with intellectual disability are creating ever greater understanding of the critical associations between human genome variations and psychological functioning throughout lifespan and across the entire intellectual ability spectrum. This review highlights the recent developments and their clinical implications for people with fragile X syndrome.

RECENT FINDINGS

There is substantial evidence for individuals of all ages and intellectual abilities being prone to psychological profiles determined not only by having a fragile X gene full mutation, but also by having premutations and intermediate alleles. The importance of these genetic contributors to mental life, if anything, increases with age. Premutation carriers are prone to neurodegenerative mid-life fragile X tremor-ataxia syndrome. Women with premutations experience premature ovarian insufficiency. Imbalances in the (gamma amino butyrie acid)-glutamate mediated postsynaptic cascade central neuronal pathways are a current focus of psychopharmacological enquiry, giving the hope of syndrome-specific medical treatments.

SUMMARY

Findings from genetic, neurological, biochemical, psychological and pharmacological research are combining to revolutionize understanding of the pathogenesis of developmental and psychological disabilities affecting individuals with fragile X syndrome irrespective of age, intelligence level and gene mutation status. Results of syndrome-specific medication trials are awaited.