Recognition and Treatment of Tardive Dyskinesia in Individualswith Intellectual Disability

Individuals with intellectual disability (ID) commonly suffer from comorbid psychiatric and behavioral disorders that arefrequently treated by antipsychotic medications. All individuals exposed tofirst- and second/third- generation antipsychotics areat risk for developing tardive dyskinesia (TD), characterized by abnormal, involuntary movements of the mouth/tongue/jaw,trunk, and extremities. TD can be highly disruptive for affected individuals and their caregivers, causing embarrassment,isolation, behavioral disturbances, and reduced functioning and quality of life. Information on TD incidence in individuals withID is limited, but 2 small US studies reported TD prevalence rates of 42-45% in inpatients with ID. The safety and efficacy ofvesicular monoamine transporter type 2 (VMAT2) inhibitors approved for treatment of TD in adults have been demonstratedin multiple clinical trials, but they excluded individuals with ID. Clinical characteristics and treatment outcomes of 5 adults(aged 28–63 years) with mild-to-severe ID and TD are presented, illustrating TD symptoms before/after treatment. Allindividuals had multiple comorbid psychiatric, behavioral, and other medical conditions, history of antipsychotic exposure, andabnormal movements affecting the tongue/mouth/jaw (n=5), upper extremities (n=5), lower extremities (n=3), and trunk(n=2), resulting in diminished ability to speak (n=2), ambulate (n=3), and perform activities of daily living (n=3). Treatmentwith valbenazine resulted in meaningful improvements in TD symptoms and improved daily functioning, demeanor, andsocial/caregiver interactions. Given the high likelihood of antipsychotic exposure in the ID population, it is appropriate toscreen for TD at every clinical visit through careful monitoring for abnormal movements and questioning theindividual/caregiver regarding abnormal movements or TD-related functional impairments (i.e., speaking, swallowing, eating,ambulating, and social functioning). In this study, 5 individuals with ID and TD received once-daily valbenazine andexperienced marked improvement in TD symptoms and daily functioning, resulting in increased quality of life for affectedindividuals and caregivers.