Sexuality and Intellectual Disability.

CASE: Amad is a wonderful 16-year-old young man from Syria who has recently relocated to the United States from his war-torn native country. In his last few years in Syria, he was primarily at home with his mother, and they sought refuge with a maternal aunt in the United States seeking asylum and treatment of Amad's disability.At 8 years of age, he had intelligence testing in the United Arab Emirates, which showed a verbal intelligence score on the Wechsler intelligence scale for children (WISC) of 68 and a performance of 64. His working memory was 67 and his processing speed was 65. On arrival in the United States, his achievement was roughly at a third-grade level in Arabic. In the year and a half that he has been in the United States, he quickly improved his English skills, which he learned as a toddler. His father remains in Syria unable to safely immigrate and his mother is raising him alone in the United States with the help of her sister.They come to you for an urgent care visit because Amad recently was accused of sexual harassment by two girls at his high school. He is in a substantially separate program but is included for lunch and technology. While in the computer laboratory, he repeatedly approached the girls and asks them to "date" him, and on 1 occasion sat behind 1 girl and repeatedly reached out to stroke her long blonde hair.His mother is distraught because she recently found out that Amad also has a Facebook page and had been attempting to contact the same two girls on social media. The girls' parents recently threatened to file criminal harassment charges and Amad's mother comes to you asking for help with making Amad stop this activity. What would you do next?

Sexuality and Intellectual Disability.

CASE: Amad is a wonderful 16-year-old young man from Syria who has recently relocated to the United States from his war-torn native country. In his last few years in Syria, he was primarily at home with his mother, and they sought refuge with a maternal aunt in the United States seeking asylum and treatment of Amad's disability. At 8 years of age, he had intelligence testing in the United Arab Emirates, which showed a verbal intelligence score on the Wechsler intelligence scale for children (WISC) of 68 and a performance of 64. His working memory was 67 and his processing speed was 65. On arrival in the United States, his achievement was roughly at a third-grade level in Arabic. In the year and a half that he has been in the United States, he quickly improved his English skills, which he learned as a toddler. His father remains in Syria unable to safely immigrate and his mother is raising him alone in the United States with the help of her sister. They come to you for an urgent care visit because Amad recently was accused of sexual harassment by two girls at his high school. He is in a substantially separate program but is included for lunch and technology. While in the computer laboratory, he repeatedly approached the girls and asks them to "date" him, and on 1 occasion sat behind 1 girl and repeatedly reached out to stroke her long blonde hair. His mother is distraught because she recently found out that Amad also has a Facebook page and had been attempting to contact the same two girls on social media. The girls' parents recently threatened to file criminal harassment charges and Amad's mother comes to you asking for help with making Amad stop this activity. What would you do next?

Psychotropic Medication Use in Children and Adolescents With Down Syndrome.

OBJECTIVE: To estimate the rate of psychotropic medication use in children and adolescents with Down syndrome (DS) and to describe age-related trends. METHODS: Data were obtained from electronic health records from 2010 to 2013 for a retrospective cohort of 832 children with DS, aged 5 to 21 years, including 5324 visits. The following medication classes: central nervous system (CNS) stimulants, selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha adrenergic agonists were examined. The distribution of rates of medication use across ages was assessed graphically and with the Cochran-Armitage trend test. Between-group comparisons of medication classes were conducted using χ. Repeated measures models with generalized estimating equations were used to assess changes in rates of medication use over time. RESULTS: Children aged 12 to 21 years were more likely to be on any medication at some point compared with children aged 5 to 11 years (25% vs 17%, respectively, p = .003). For 5 to 11 year olds, the odds of being on a psychotropic medication increased with age for all medication classes studied. For 12 to 18 year olds, the odds of being on a CNS stimulant significantly decreased with increasing age (odds ratio: 0.73, 95% confidence intervals, 0.58-0.91), whereas the odds of being on a medication from one of the other classes was stable. CONCLUSION: Changes in psychotropic medication use across the age span in children with DS suggest that the type and severity of neurobehavioral problems in this population likely also change over time. These findings will inform future research on the common mental health conditions and treatments for children with DS.

Vitamin D status in children and young adults with perinatally acquired HIV infection.

BACKGROUND & AIMS: To assess vitamin D (Vit-D) [serum 25-hydroxyvitamin D (25-OHD) concentrations] in children and young adults with perinatally acquired HIV compared to geographically similar healthy children. METHODS: 25-OHD in children and young adults with HIV was compared to a healthy group. Vit-D deficiency and insufficiency were defined as 25-OHD <11 ng/mL and 25-OHD <30 ng/mL, respectively. RESULTS: Children with HIV (n = 81), mean age 13.8 ± 4.1 years, 48% female, 83% Black, were compared to healthy subjects (n = 372), mean age 12.4 ± 3.4 years, 51% female, 37% Black. For the HIV group, 84% were on HAART, 54% had plasma HIV RNA <400 cpm, and 35% had moderate to severe immunosuppression (CD4+ count <500 cells/mm). Vit-D deficiency/insufficiency was present in 36% and 89% of those with HIV, and 15% and 84% of the comparison group, respectively. Vit-D deficiency was more prevalent in those with HIV (unadjusted odds ratio: 3.25; 95% CI: 1.9-5.5). For both groups, prevalence of Vit-D deficiency increased with age, BMI Z-score, Black race, and in winter/spring months. Vit-D deficiency was associated with a greater degree of immunosuppression in the subjects with HIV. CONCLUSIONS: Vit-D deficiency was increased in subjects with perinatally acquired HIV and may be associated with disease severity.