Health Profile of Australian Adolescents with Intellectual Disability

Round 1

Reviewer 1 Report

Thank you for the opportunity to review the manuscript "Health profile of Australian adolescents with intellectual disability." This paper aims to describe symptoms, chronic illnesses, level of functioning, and behaviour among Australian adolescents with intellectual disability. The authors have written an interesting manuscript. At the same time there are some issues to consider. I discuss these concerns further and make specific suggestions for further improvement. I hope these will be helpful to them.

Abstract

Background. Please add "cared reported" before "chronic illness".

Introduction

Introduction is somewhat brief. Please, describe further what is already known about the health status of adolescents with intellectual disability and give reasons to compare participants according to the type of school attended.

Also, introduction might benefit from some rewording to connect similar ideas and avoid the repetitive ones (e.g., page 2, lines 37 and 46).

Method

Page 2, line 68. I wonder to what extent data from 2007-2010 might be extrapolate to the present. I find this as an important limitation.

 

Page 2, line 75. Authors stated that “participants attending an SEU were usually less severely disabled that SES students”. Other variables such as level of severity might account for part of the differences between SESs and SEUs. In this sense, statistical analysis were quite simple. More complex analysis (e.g. analysis of covariance or multiple regression analysis), including multiple variables (e.g. level of severity, socioeconomic status, gender, age groups etc.) and their effect size,  would have been more appropriate to delve into differences between participants.

Page 2, lines 83 and 84. For readability purposes, please include the number of participants in each group (e.g., between brackets). Also, it may be helpful to indicate that both groups completed the baseline questionnaire.

Page 2, lines 85-87. Please provide references in which readers can consult the questions included in the CHAP, the baseline questionnaire, and the statements from the health intervention package. Or, add them as Annexes.

Page 3. How were the Baseline Questionnaire and the CHAP booklets developed? Are these instruments valid and reliable?

 

Page 3, line 100. Please, explain further how level of functioning was recorded. Did authors use a standardized measure to assess level of functioning? What were the response options?

Page 3, line 112. Were these symptoms listed? How was the answer format?

 

Results

How was diagnosis of intellectual disability at schools and participant diagnosis from carers verified?

Why only 176 participants from the intervention group returned their completed health check booklets? I wonder to what extent results from 176 participants (e.g. concerning symptoms, dental, hearing or visual problems, among others) might be representative of the adolescent Australian population with IDD.

A health intervention is mentioned in the method section. However, little is stated about this in the manuscript. There were differences between control and intervention groups after receiving the intervention package? Authors should mention this or refer to the corresponding reference.

Page 5. Table 1. Percentages do not add to 100% at “Aetiology of Intellectual Disability” in Special Education Unit and “General health status” in the total sample”

Page 6. Lines 165-167. Page 8, line 180. Where do these numerical values come from?

Page 7. Table 3. Please, remove “0” from “0.79”. Check this across the document.

Page 7, lines 188-191. Apart form this vision and hearing problems, I wonder which other symptoms did carers report, as stated in page 3, line 112. By the way, did you find discrepancies among GP and carers? Just curious.

Page 8, Table 4. Authors reported significant differences at the risk difference column. What statistical test did you use to calculate this?

Discussion

Page 9, line 234. WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Also, at page 2, lines 42-43, authors mentioned some aspects that may contribute to the person’s wellbeing, however they are missing at the discussion. Given this and the high rates of psychopathology ascertained by the DBC-P24, I encourage authors to include other recommendations that contibute to physical, mental and social wellbeing. For this, consulting the social-ecological model of disability, the supports paradigm or areas as self-determination, personal development, social inclusion, self-advocacy, and rights, etc. may be helpful. Also, please consider referring to specific evidence-based interventions and practices to inform families, practitioners, and policy makers.

Author Response

We are very grateful for your time and effort.

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

This study serves as a reminder that intellectual disability is significantly linked to health care issues, and that perhaps we need to draw back from our efforts to de-medicalize the supports and services for people with intellectual disability.   I believe that the data will be quite useful in making arguments that intellectual disability is not distinct from healthcare, but rather that healthcare and intellectual disability services need to be better integrated.    I would have welcomed some sort of comparison group of individuals without intellectual disability.  To some extent, the argument seems unnecessary, but I would have had greater comfort in knowing what values might be expected among the general school population.   It is a shame that the data are so old.  I wonder if the authors could strengthen their argument that the data might still be representative.

question - do the authors have data on psychotropic medications?   Some of the conditions listed could perhaps be secondary to medication, and medication use itself would be of interest.  

 

Author Response

We are grateful for your time and effort. Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

A welcome contribution to the literature on health of people with intellectual disability with a specific focus on adolescents. A few minor issues that would benefit from further clarification in the paper include:

the age group is 10-21 years - can you provide reference for this specific age group as adolescent, I would've expected cut off to be 18/19 years of age;

under section 3.4 please clarify if the first part of the is completed by the adolescent, parent or both or other perhaps?

Paragraph under table 2, the text six point six percent could be rephrased as almost seven percent

Under 4.3 recommendations commentary on how transition points during school (moving from primary to secondary, change in geographic location of school etc) would impact on health checks and what needs to be put in place to manage this;

further development of policy recommendations in section 4.3 would be welcomed

conclusion quite brief, please consider stronger concluding paragraph with re-iteration of why this is important.

Author Response

We are grateful for your time and effort.

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Authors have added changes that improve the quality of the manuscript. Therefore, I propose it be published.