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Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability

  • Sarah Buckley (a1), Philip Dodd (a2), Amanda Burke (a3), Suzanne Guerin (a4), John McEvoy (a5) and John Hillery (a6)...
Abstract
Aims and Method

Anecdotal evidence suggests that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in adults and people of all ages with learning disability. This study examines the clinical practice of Irish consultant psychiatrists when assessing and treating symptoms of ADHD in children and adults with and without a learning disability. A postal questionnaire was sent to 302 consultant psychiatrists working in Ireland.

Results

Ninety-seven consultants (32%) responded, 62 working in general adult psychiatry, 23 in child and adolescent psychiatry and 12 in learning disability. Overall, respondents were more confident about making a diagnosis of ADHD in people without a learning disability. Those working with children were significantly more confident in diagnosing and treating ADHD than those working with adults, irrespective of whether the patient had a learning disability.

Clinical Implications

There is general agreement that symptoms of ADHD exist in children and adults both with and without a learning disability. It is likely that ADHD may be undertreated in patients with learning disability, especially in the adult population.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
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Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability

  • Sarah Buckley (a1), Philip Dodd (a2), Amanda Burke (a3), Suzanne Guerin (a4), John McEvoy (a5) and John Hillery (a6)...
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eLetters

Response

Prathibha Rao, Senior House Officer In Psychiatry
09 August 2006

The authors have raised a very important gap in the training and service provision, but before accepting the results of the study, there are certain questions which are worth thinking about.

Firstly, to answer the first outcome - The authors question whether consultants believe that ADHD exists. The response bias, where in the response, rather the lack of it from general adult consultants, could haveseriously affected the results. I would only imagine that it could be really difficult for a person who does not believe in the diagnosis of ADHD to continue to sustain himself/herself in child and adolescent psychiatry. Hence, the fact that the response has favoured the presence ofADHD could be a reflection of this bias in response. Perhaps, a better wayto overcome the limitation of the poor response would be for the authors to ensure a better ascertainment, by employing methods like a telephone survey or personal contact for a brief interview, rather than just relyingon postal questionnaires.

Secondly, the authors mention that consultants might be more confident in making a diagnosis of ADHD in patients without learning disability than one with. However, is not this a common problem one has would encounter, when dealing with a co morbid disorder in any one, eitherwith or without a learning disability? So, to extrapolate this finding to a diagnostic overshadowing to this specific population is slightly misgiving.

Also, to answer this question, the authors would have got a more useful response by targeting only the child psychiatrists and the learningdisability psychiatrists. Not many general adult consultants work with people with learning disabilities and they would find diagnosing any mental illness in the learning disabilities a task, leave alone ADHD.

Research into the presentation of ADHD in learning disabilities is limited and very frequently encountered in routine practice. This puts theclinician into a dilemma in diagnosing, as problems of poor concentration,impulsivity, short attention span can present in both the conditions and teasing out one from the other is next to impossible. In my experience of working in ADHD teams, such cases would usually be referred to clinical psychologists, and hence including psychologists in these kinds of surveysmight be more helpful. However,the area of difficulty highlighted in this article is important and concerns like this will pave the way for better understanding and management in the future.
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