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Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a 'suggested clinical immobilization test'. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35–15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37–8.64]), and RLS (OR: 7.00, p = 0.01, [1.49–32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82–12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54–22.1]), RLS (OR: 4.05, p = 0.01, [1.33–12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17–6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors. [ABSTRACT FROM AUTHOR]

Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder. [ABSTRACT FROM AUTHOR]

The DSM-5 condition known as autism spectrum disorder is usually a lifelong diverse condition whose etiology is not fully elucidated. Over the past few decades, its prevalence has increased, and the relationship with other neurodevelopmental disorders has evolved. In BC, there is a well-defined process for making the diagnosis. Treatment interventions are available for both the core symptoms of autism in early childhood and comorbid conditions throughout the lifespan. Supports are available through provincial programs and the health care sector but may be difficult for families to access. We discuss the advocacy burden for the families whose children have the most complex needs and impairment. [ABSTRACT FROM AUTHOR]

A range of maladaptive behaviors, including irritability and aggression, are often encountered in autism spectrum disorder. Challenges in complex clinical decision making and management exist, and off-label antipsychotic prescribing is increasing in Canada. A literature review of various treatments, limited to randomized controlled trials in the pediatric population, was used to develop an algorithm for evaluating and managing irritability and aggression in autism spectrum disorder within a Canadian context, which is supported by expert consensus. Holistic consideration of biomedical, psychiatric, psychosocial, environmental, and developmental factors that affect behavior is emphasized. The algorithm highlights the multifactorial contributors to irritability and aggression in autism spectrum disorder and reserves the use of antipsychotic medication for managing the most severe and refractory cases. A comprehensive evaluation of the drivers of behavior when addressing irritability and aggression in autism spectrum disorder is crucial to identify treatable contributors and institute appropriate management. [ABSTRACT FROM AUTHOR]

Children with neurodevelopmental disorders are at increased risk of developing mental health difficulties, and when neurodevelopmental and psychiatric disorders do co-occur, children and their families frequently face multiple barriers as they try to access services and resources. A literature review indicates that there is a lack of specialized mental health services for patients with a dual diagnosis, and the resulting inadequate level of community supports has placed the burden of care on families. Services for children in BC with a dual diagnosis are delivered by different agencies and programs, primarily under the Ministry of Children and Family Development and the province's health authorities. Depending on the specifics of the diagnoses, children may be eligible for community support services, outpatient mental health services, and inpatient psychiatry services. However, because of system fragmentation and insufficient collaboration and communication, obtaining these services can be challenging and many children are falling through the cracks. Four clinical vignettes illustrate how children and their families trying to access support face barriers, including bureaucratic processes, lack of respite, out-of-home service obstacles, and limited specialized training for care providers. Policy changes are needed to ensure a wraparound approach to care based on integrative interagency and cross-agency practices. [ABSTRACT FROM AUTHOR]

Genetic contribution to mental illness, particularly schizophrenia, is considerable. Reporting chromosomal abnormalities which coincide with schizophrenia can suggest possible loci of interest. We report a case of a young woman with a rare chromosomal abnormality, early onset schizophrenia and mild intellectual disability. We suggest that our patient's chromosomal abnormality played a role in her intellectual disability and her schizophrenia. While the genetic implications are unclear, this case is an example of the richness and complexity of the possible psychiatric presentations in individuals with intellectual disability. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Problems and Questions in the Dual Diagnosis of Schizophrenia and Intellectual Disability," by David Bresch in a 2004 issue.

Objective : This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods : A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results : Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n  = 28) with psychiatric (96.7%; n  = 29) and physical (90%; n  = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions : The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder., Competing Interests: No potential conflict of interest was reported by the authors., (© The British Society of Developmental Disabilities 2022.)

The delivery of mental health services to persons with Intellectual Disability (ID) in British Columbia (BC), Canada, is worth documenting because BC is one of the few jurisdictions in the world to completely close its institutions for people with ID. This paper documents the delivery of mental health care in BC for this population and contrasts the dream versus the reality of community living for people with dual diagnosis (mental illness coupled with an intellectual disability).