BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9–335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

https://pediatrics.aappublications.org/content/pediatrics/early/2020/06/15/peds.2019-2623.full.pdf

Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments

Rho-class small GTPases are implicated in basic cellular processes at nearly all brain developmental steps, from neurogenesis and migration to axon guidance and synaptic plasticity. GTPases are key signal transducing enzymes that link extracellular cues to the neuronal responses required for the construction of neuronal networks, as well as for synaptic function and plasticity. Rho GTPases are highly regulated by a complex set of activating (GEFs) and inactivating (GAPs) partners, via protein:protein interactions (PPI). Misregulated RhoA, Rac1/Rac3 and cdc42 activity has been linked with intellectual disability (ID) and other neurodevelopmental conditions that comprise ID. All genetic evidences indicate that in these disorders the RhoA pathway is hyperactive while the Rac1 and cdc42 pathways are consistently hypoactive. Adopting cultured neurons for in vitro testing and specific animal models of ID for in vivo examination, the endophenotypes associated with these conditions are emerging and include altered neuronal networking, unbalanced excitation/inhibition and altered synaptic activity and plasticity. As we approach a clearer definition of these phenotype(s) and the role of hyper- and hypo-active GTPases in the construction of neuronal networks, there is an increasing possibility that selective inhibitors and activators might be designed via PPI, or identified by screening, that counteract the misregulation of small GTPases and result in alleviation of the cognitive condition. Here we review all knowledge in support of this possibility.

https://www.mdpi.com/1422-0067/19/6/1821/pdf

Rho GTPases in Intellectual Disability: From Genetics to Therapeutic Opportunities

Down syndrome: Neurobiological alterations and therapeutic targets

Objective: To explore the impact of medical interventions on reducing the prevalence of mental retardation (MR) in the United States over the last 50 years. Design: We reviewed the medical literature and other data from 1950 to 2000 to construct estimates of the general and condition-specific prevalence of MR in the United States over time. We further explored the existing literature to document historically important influences on condition-specific prevalence, including the year that an effective intervention was introduced, the likelihood of success of the intervention, and the availability of such interventions nationwide. Specific conditions included congenital syphilis, Rh hemolytic disease of the newborn, measles, Haemophilus influenzae type B meningitis, congenital hypothyroidism, phenylketonuria, and congenital rubella syndrome. Setting: Twentieth-century North America. Participants: Children with MR or 1 of the 7 specific conditions listed earlier. Main Outcome Measures: Case-specific and general prevalence of MR from 1950 to 2000. Results: The prevalence of MR caused by a number of specific medical conditions has decreased sharply over the last 50 years. However, the incidence of each of these conditions is relatively low, and cases of MR due to these conditions represent, at most, 16.5% of the total number of cases of MR in 1950. Conclusion: Although specific medical interventions have prevented thousands of cases of MR, their contribution to the overall prevalence of MR is relatively small.

Impact of specific medical interventions on reducing the prevalence of mental retardation. Commentary

The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID-19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID-19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jppi.12352

Guidance for the Treatment and Management of COVID-19 Among People with Intellectual Disabilities.

The prevalence of intellectual disabilities is often quoted at 1 %. A meta-analysis of articles published between 1980 and 2009 confirmed this prevalence. Changes in diagnostic practices, population characteristics, and exposure to known risk factors in recent years place this estimate in question and make it imperative to examine more recent studies of prevalence and incidence. Twenty relevant articles were obtained from five databases (PubMed, Embase, PsycInfo, Cochrane, and MEDLINE), published between 2010 and 2015. Most studies (n = 17) only reported prevalence estimates, while two provided incidence estimates. Various methodologies were applied, with the majority of studies (n = 16) using administrative data. Heterogeneity in study settings, methodologies, age groups, and case definitions contributed to a range of prevalence estimates (0.05 to 1.55 %). Future research should include reproducible and consistent definitions of intellectual disabilities, provide age-specific estimates, and monitor changes in prevalence over time.

/pdf/systematic-review-of-the-prevalence-and-incidence-of-48wbhh6nh2.pdf

Meagan Milton

Papers

Systematic Review of the Prevalence and Incidence of Intellectual Disabilities: Current Trends and Issues