A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents

Helen Leonard; Alicia Montgomery; Brittany Wolff; Elissa Strumpher; Anne Masi; Susan Woolfenden; Katrina Williams; Valsamma Eapen; Amy Finlay-Jones; Andrew Whitehouse; Martyn Symons; Melissa Licari; Kandice Varcin; Gail Alvares; Kiah Evans; Jenny Downs; Emma Glasson

doi:10.3389/fpsyt.2022.926681

A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents

Front Psychiatry. 2022 Aug 25:13:926681. doi: 10.3389/fpsyt.2022.926681. eCollection 2022.

Authors

Helen Leonard¹, Alicia Montgomery², Brittany Wolff¹, Elissa Strumpher¹, Anne Masi², Susan Woolfenden², Katrina Williams³, Valsamma Eapen², Amy Finlay-Jones¹, Andrew Whitehouse¹, Martyn Symons¹, Melissa Licari¹, Kandice Varcin¹, Gail Alvares¹, Kiah Evans¹, Jenny Downs¹, Emma Glasson¹

Affiliations

¹ Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia.
² School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
³ Department of Paediatrics, Monash University, Clayton, VIC, Australia.

Abstract

Aim: This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID).

Methods: Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE.

Results: Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high.

Conclusion: Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].

Keywords: antenatal; data linkage; intellectual disability; maternal health; population data; risk factor; sociodemographic; systematic review.

Publication types

Systematic Review