In Reply

Prof. Gahr is right to mention the aspect of underage people with intellectual disability, which we did not consider in our study (1). The reason for this omission was that in psychiatric clinics/hospitals and in practice, a separation exists between child and adolescent psychiatry and the treatment of adult psychiatric patients. We can assume that very few neurologists or psychiatrists have worked in child and adolescent psychiatric settings. Most neurologists/psychiatrists in private practice do not treat children and adolescents either. We agree with Prof. Gahr that this patient population is particularly vulnerable. In terms of the diagnostic spectrum, we do not expect any relevant differences, however, since autism, cerebral palsy, organic psychosyndromes are likely to be similarly pronounced in youngsters as in adults. In any case, the Central Institute (CI) has the data for underage patients, but we did not analyze those for the reasons mentioned earlier. The high prescribing prevalence of psychoactive drugs (38.8%) did strike us too and was for a long time the subject of manuscript revisions. We hope that we were able to reflect our results sufficiently well in the discussion section. The main reason is probably that psychological problems or challenging behaviors often constitute reasons for accessing consultations in ID. Or, to put it differently, the most simple cases without the need for administration of psychoactive drugs are probably underrepresented in our study. We agree with Prof. Gahr that psychotherapy is also underrepresented, or rather, that it is barely undertaken in real-life healthcare settings, with waiting times being very long even in persons without intellectual disability. The identification and therapy of affective disorders in people with intellectual disability are certainly also subject to improvement.