The RCPsych Article of the Month for November is ‘Assessing and managing attention-deficit hyperactivity disorder in people with intellectual disability’ and the blog is written by authors Bhathika Perera and Ken Courtenay and published in BJPsych Advances.

We know that the prevalence rates of physical and mental disorders are higher in people with intellectual disabilities than in the general population. ADHD is one of those neurodevelopmental disorders where clinicians appear reluctant to make the diagnosis in people with ID. Of course, diagnosing ADHD-ID can be difficult for many reasons such as other diagnoses overshadowing the core signs of ADHD. Despite clearly observing and documenting symptoms of ADHD (without calling it ADHD), we are slow to consider the diagnosis. We always wonder why health professionals are very reluctant to consider the diagnosis of ADHD in people with ID that has led us to write the article.

In this paper, we present a guide that a practicing psychiatrist can use to plan the assessment and treatment of ADHD. We address some of the complexities faced when diagnosing ADHD in people with ID. Once the diagnosis is made, the task is to learn what treatment options the person would benefit from – medication, behavioural interventions, or both. We provide guidance on the options available to practising clinicians. We aim to make the diagnosis and treatment process simpler so patients with ID get the same level of treatment that their counterpart without ID would receive.

We admit that we do not provide all the answers as research in ADHD-ID is limited. How often do we hear that “more research is needed”? It is now time to push the research agenda further to answer the questions that need to be answered on common neurodevelopmental disorders in people with ID. We suggest starting with the diagnosis and management of ADHD-ID because of its potential to change the life trajectories of some people with ID through thorough and accurate assessment and the application of effective interventions.

If you like to read into further details of diagnosis and management of ADHD in people with ID, please read Royal College of Psychiatrists College Report (CR230).

This very practical paper is relevant not just to clinicians working with those who have intellectual disability, but also to adult psychiatrists, who have to manage many with borderline and mild ID. It discusses the assessment process in detail and provides comprehensive information on the range of pharmacological and non-pharmacological treatments. Co-morbidities are also considered. The clarity of writing and the layout and overall presentation make it a worthy candidate for Article of the Month.

Patricia Casey

BJPsych Advances, Editor-in-Chief