Lessons learned from our elders: how to study polypharmacy in populations with intellectual and developmental disabilities.

Polypharmacy is the concurrent use of multiple medications, including both psychotropic and non-psychotropic drugs. Although it may sometimes be clinically indicated, polypharmacy can have a number of negative consequences, including medication nonadherence, adverse drug reactions, and undesirable drug-drug interactions. The objective of this paper was to gain a better understanding of how to study polypharmacy among people with intellectual and developmental disabilities (IDD). To do this, we reviewed literature on polypharmacy among the elderly and people with IDD to inform future research approaches and methods on polypharmacy in people with IDD. Results identified significant variability in methods used to study polypharmacy, including definitions of polypharmacy, samples studied, analytic strategies, and variables included in the analyses. Four valuable methodological lessons to strengthen future polypharmacy research in individuals with IDD emerged. These included the use of consistent definitions of polypharmacy, the implementation of population-based sampling strategies, the development of clinical guidelines, and the importance of studying associated variables.

Primary care of adults with developmental disabilities in Ontario.

The health status and healthcare of adults with developmental disabilities have not been well-studied in Ontario, due to the absence of population-based data. To address this deficit, the Health Care Access Research and Developmental Disabilities (H-CARDD) program - a provincial partnership of scientists, policymakers and clinicians - has used existing provincial-level administrative data to provide descriptive information on the health of adults with developmental disabilities and the quality of their primary care relative to other adults. H-CARDD's findings have revealed many gaps in the care of adults with developmental disabilities. While primary care providers are critical to achieving needed changes, the broader healthcare context and infrastructure also need to be considered.

Age at diagnosis of autism spectrum disorders in four regions of Canada.

OBJECTIVES: Early diagnosis of autism spectrum disorders ("autism") may lead to better treatment outcomes, reduces the stress parents experience when they do not understand the reasons for their child's behaviour, and empowers parents to make choices such as seeking genetic counseling. We examined the age at which Canadian children are diagnosed with autism, and analyzed whether there are geographic or temporal variations or differences by sex or diagnostic subtype. METHODS: As part of an autism surveillance program, in 2002/2003 we began collecting information on children with autism in Manitoba, Southeastern Ontario, Prince Edward Island, and Newfoundland and Labrador. For the analysis presented in this paper, we included children identified for our surveillance program who were diagnosed between 1997 and 2005 (n = 769). RESULTS: We found significant inter-regional differences in age at diagnosis, with Newfoundland and Labrador having the lowest median age at diagnosis (39.0 months) and Southeastern Ontario the highest (55.0 months). Diagnostic subtype was significantly associated with age at diagnosis in all regions. Southeastern Ontario was the only region where the overall age at diagnosis increased over time (p = 0.004), although in Manitoba the age at which children were diagnosed with PDD-NOS also increased significantly over the study period (p = 0.021). CONCLUSIONS: Our findings demonstrate that there are geographic differences and other sources of variation in the age at which Canadian children are diagnosed with autism. Further study is warranted to understand the factors contributing to these differences. Such research would inform best practices for early detection and timely access to treatment.