Attention Deficit Hyperactivity Disorder in Adults with Intellectual Disability: Report 230 of the Royal College of Psychiatrists

The purpose of this article is to discuss the Royal College of Psychiatrists' Report 230, "Attention deficit hyperactivity disorder (ADHD) in individuals with intellectual disability, which aims to reduce the frequent misdiagnosis of this condition in people with ID, as shown in the case vignette that begins our commentary. The College Report is a helpful resource for clinicians and providers in using evidence-based practices to support and treat ADHD in persons with ID, filling a gap that was previously critically underserved. However, it contains certain methodological and content flaws that should be addressed in future revisions. The evaluation of the available evidence was not carried out through a validated grading system and it is unclear what procedure was used to achieve a consensus on the various recommendations. Furthermore, there is a lack of information on psychopathological aspects that cross diagnostic categories and are frequently encountered in daily practice, and the level of detail and precision of clinical indications is low, especially in relation to the numerous patients with marked cognitive and communication difficulties. Future updates of the Report should take into account differential diagnosis, including semeiological details and explicit references to a wide range of psychiatric, neurologic, physical, and developmental issues.