501
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Neuhaus E, Bernier RA, Tham SW, Webb SJ. Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents With Autism Spectrum Disorder. Front Psychiatry 2018; 9:515. [PMID: 30405456 PMCID: PMC6204460 DOI: 10.3389/fpsyt.2018.00515] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 12/18/2022] Open
Abstract
Individuals with autism spectrum disorder (ASD) are at heightened risk of psychiatric comorbidities across the lifespan, including elevated rates of internalizing, externalizing, and self-injurious behaviors. Identification of medical comorbidities that contribute to these concerns may elucidate mechanisms through which psychiatric concerns arise, as well as offer additional avenues for intervention. Gastrointestinal (GI) conditions are of particular interest, as they are prevalent among those with ASD, may share genetic or neurobiological etiologies with the core features of ASD, and are linked with psychiatric difficulties in the general population. In this paper, we draw on data from nearly 2,800 children and adolescents with ASD within the Simons Simplex Collection to characterize the unique contributions of (1) autism symptoms, (2) psychosocial factors (child's age, sex, verbal and nonverbal IQ, adaptive behavior, race, and household income), and (3) GI concerns with respect to multiple psychiatric outcomes. Multiple regression models revealed unique contributions of ASD symptoms and multiple psychosocial factors such as verbal IQ, adaptive behavior, and family income to internalizing, externalizing, and self-injurious behavior. In general, higher levels of psychiatric symptoms were associated with more ASD symptoms, higher verbal IQ, lower adaptive behavior skills, and lower family income. Furthermore, levels of GI symptoms accounted for unique variance in psychiatric outcomes over and above these other factors, linking increased GI problems with increased psychiatric symptoms in children with ASD. Taken together, results indicate that the presence and quantity of GI symptoms should be considered when evaluating psychiatric and behavioral concerns among children with ASD, and that treatment of GI conditions may be an important component in alleviating a broad array of mental health concerns in this group.
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Affiliation(s)
- Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
| | - Raphael A Bernier
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - See Wan Tham
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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502
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Wallace GL, Llewellyn C, Fildes A, Ronald A. Autism spectrum disorder and food neophobia: clinical and subclinical links. Am J Clin Nutr 2018; 108:701-707. [PMID: 30321276 DOI: 10.1093/ajcn/nqy163] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Autism spectrum disorder (ASD) has been linked with eating- and feeding-related atypicalities, including food neophobia (FN) (refusal to try unfamiliar foods), since its earliest description. Nevertheless, whether associations between ASD traits and FN extend subclinically into the broader population of children and their potential additive health impacts remains unexplored. Objective We examined ASD-control group differences in FN and ASD trait-FN trait associations, as well as the ability of FN and autistic traits to predict one index of later health-related outcomes [body mass index (BMI)]. Design Participants in the present study were a large community-based sample of 8- to 11-y-olds (n = 4564), including a relatively small group of children diagnosed with ASD (n = 37). Parents of these 8- to 11-y-old children completed assessments of FN and autistic traits and provided height and weight metrics at 12 y of age. Results Children with ASD were rated as more food neophobic than their same-age non-ASD peers (2.67 ± 0.83 compared with 2.22 ± 0.73; P < 0.001), and there were subclinical associations between FN and ASD traits (social, communication, and restricted/repetitive behavior) in this community-based sample of children (P < 0.05). Moreover, whereas FN alone predicted lower BMI, the interaction of FN and ASD traits predicted higher BMI (P ≤ 0.01), suggesting that elevated ASD traits in combination with FN exert opposing influences on weight compared with FN alone. Conclusions These findings implicate clinical and subclinical connections between ASD traits and feeding behaviors that could affect health outcomes and therefore should be further explored in future studies of shared etiology and intervention strategy.
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Affiliation(s)
- Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
| | - Clare Llewellyn
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Alison Fildes
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Angelica Ronald
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom
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503
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Abstract
PURPOSE OF REVIEW This article discusses common issues surrounding transition to adulthood in youth with autism spectrum disorder (ASD). We review recent evidence on co-occurring medical and mental health conditions and topics of education and employment, sexuality and relationships, independent living, and financial support. RECENT FINDINGS Transitioning individuals with ASD have increased risk for several medical and behavioral health comorbidities and should be routinely screened for co-occurring conditions. Evidence on interventions for mental health disorders is limited but emerging, particularly with respect to mindfulness training and cognitive behavioral therapy. Many autistic adults or their families express a desire for independent living, participation in education/employment, and intimacy and social relationships, but they often lack skills and/or resources to successfully achieve these outcomes. The time of transition to adulthood for adolescents with ASD is an opportunity for physicians to provide anticipatory guidance and necessary supports around issues of community participation. To allow time for planning, these discussions should occur well before the child reaches adulthood. Clinicians should also routinely screen for and address medical and/or behavioral health comorbidities.
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Affiliation(s)
- Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
| | - Judith S Miller
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Natalie Stollon
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Raghuram Prasad
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan J Blum
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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504
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Rubenstein E, Bishop-Fitzpatrick L. A matter of time: The necessity of temporal language in research on health conditions that present with autism spectrum disorder. Autism Res 2018; 12:20-25. [PMID: 30184325 DOI: 10.1002/aur.2010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Abstract
Relatively consistent findings from recent studies using population-level data identify heightened physical and psychiatric morbidity in autistic people compared to the general population. Health problems that commonly present with autism spectrum disorder (ASD) are generally discussed in the literature as "co-occurring" or "comorbid" regardless of their known or hypothesized causal mechanisms. In this commentary, we introduce a new temporally focused terminology to describe health conditions that present with ASD. Emphasizing the temporal development of health conditions in research will help the field understand whether conditions are (1) "truly co-occurring" (share an etiologic origin with ASD in utero and are a defining characteristic of a subphenotype), (2) "resulting" (caused by ASD related disparity or the health effect of behaviors developed to cope with ASD symptoms), or (3) "associated" (conditions more common in individuals with ASD with etiology not yet known or hypothesized, or an artifact of diagnostic process or trends). Whether a health condition is "truly co-occurring", "resulting", or "associated" has implications for how we design interventions to prevent and treat health conditions in people on the autism spectrum. Ultimately, we think that using clear and temporally focused language can set us on a path to better deduce etiology and develop effective prevention and intervention efforts for health conditions that impact the lives of autistic individuals. We hope that this approach to temporal language to describe health conditions that present with ASD promotes thought and discussion in research, advocate, and autistic communities. Autism Research 2019, 12: 20-25. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Research finds autistic people have more health problems than the general population but we do not understand why. In this commentary, we argue researchers need to use language describing the timing of health problems in autistic people, specifying whether problems truly co-occur (share a cause), result from autism-related disparities, or are more common in autistic people for an unknown reason. Clarifying language can provide more specificity in research and improve efforts to prevent and treat health problems in autistic people.
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Affiliation(s)
| | - Lauren Bishop-Fitzpatrick
- The Waisman Center, Madison, Wisconsin.,School of Social Work, University of Wisconsin, Madison, Wisconsin
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505
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Tint A, Hamdani Y, Sawyer A, Desarkar P, Ameis SH, Bardikoff N, Lai MC. Wellness Efforts for Autistic Women. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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506
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Rydzewska E, Hughes-McCormack LA, Gillberg C, Henderson A, MacIntyre C, Rintoul J, Cooper SA. Prevalence of long-term health conditions in adults with autism: observational study of a whole country population. BMJ Open 2018; 8:e023945. [PMID: 30173164 PMCID: PMC6120653 DOI: 10.1136/bmjopen-2018-023945] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To investigate the prevalence of comorbid mental health conditions and physical disabilities in a whole country population of adults aged 25+ with and without reported autism. DESIGN Secondary analysis of Scotland's Census, 2011 data. Cross-sectional study. SETTING General population. PARTICIPANTS 94% of Scotland's population, including 6649/3 746 584 adults aged 25+ reported to have autism. MAIN OUTCOME MEASURES Prevalence of six comorbidities: deafness or partial hearing loss, blindness or partial sight loss, intellectual disabilities, mental health conditions, physical disability and other condition; ORs (95% CI) of autism predicting these comorbidities, adjusted for age and gender; and OR for age and gender in predicting comorbidities within the population with reported autism. RESULTS Comorbidities were common: deafness/hearing loss-14.1%; blindness/sight loss-12.1%; intellectual disabilities-29.4%; mental health conditions-33.0%; physical disability-24.0%; other condition-34.1%. Autism statistically predicted all of the conditions: OR 3.3 (95% CI 3.1 to 3.6) for deafness or partial hearing loss, OR 8.5 (95% CI 7.9 to 9.2) for blindness or partial sight loss, OR 94.6 (95% CI 89.4 to 100.0) for intellectual disabilities, OR 8.6 (95% CI 8.2 to 9.1) for mental health conditions, OR 6.2 (95% CI 5.8 to 6.6) for physical disability and OR 2.6 (95% CI 2.5 to 2.8) for other condition. Contrary to findings within the general population, female gender predicted all conditions within the population with reported autism, including intellectual disabilities (OR=1.4). CONCLUSIONS Clinicians need heightened awareness of comorbidities in adults with autism to improve detection and suitable care, especially given the added complexity of assessment in this population and the fact that hearing and visual impairments may cause additional difficulties with reciprocal communication which are also a feature of autism; hence posing further challenges in assessment.
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Affiliation(s)
- Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Christopher Gillberg
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Gillbergcentrum/Gillberg NeuropsychiatryCentre, Göteborgs Universitet/University of Gothenburg, Göteborg, Sweden
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cecilia MacIntyre
- Census User Needs, Content and Benefits, National Records of Scotland, Edinburgh, UK
| | - Julie Rintoul
- Health and Social Care Analysis, Scottish Government, Edinburgh, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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507
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Chandler RJ, Russell A, Maras KL. Compliance in autism: Self-report in action. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1005-1017. [DOI: 10.1177/1362361318795479] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous research indicates that autistic individuals are more likely to be bullied, and that they experience heightened anxiety and diminished self-esteem. These factors are known to predict heightened compliance, which is the tendency to agree with or carry out the requests and demands of others. This has a range of potentially serious consequences, particularly for an autistic person. This study utilised self-report (the Gudjonsson Compliance Scale) and behavioural measures of compliance (the door-in-the-face task) with 26 autistic and 26 typically developing adults. Participants also completed measures of early life bullying experiences, anxiety and self-esteem. Autistic participants were more compliant on both self-report and experimental tasks, and they reported more bullying experiences, higher anxiety and reduced self-esteem. Looking at both groups, bullying, anxiety and self-esteem were all correlated with self-reported compliance on the Gudjonsson Compliance Scale, yet only self-esteem was a unique predictor. None of these predictor variables related to behavioural compliance on the door in the face; nor did Gudjonsson Compliance Scale scores predict door-in-the-face performance, which may be better explained by situational and motivational factors. Findings have important implications for a range of real-life settings including requests made in the context of research, schools, the criminal justice system and the workplace.
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508
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Tromans S, Chester V, Kiani R, Alexander R, Brugha T. The Prevalence of Autism Spectrum Disorders in Adult Psychiatric Inpatients: A Systematic Review. Clin Pract Epidemiol Ment Health 2018; 14:177-187. [PMID: 30197663 PMCID: PMC6118035 DOI: 10.2174/1745017901814010177] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/22/2018] [Accepted: 06/16/2018] [Indexed: 12/27/2022]
Abstract
Background: Whilst the prevalence of autism spectrum disorders in adults within the community setting is well-established, less is known about the prevalence among adults based within a psychiatric inpatient setting. Objective: To conduct a systematic literature review pertaining to the prevalence of autism spectrum disorders among the adult psychiatric inpatient population. Method: Eligibility criteria included: (a) investigation of the prevalence of autism spectrum disorders (b) adult psychiatric inpatient study population (c) published in English language. Electronic databases accessed included PubMed, Medline, CINAHL, PsycINFO and EMBASE. Additionally, the ancestry method was utilised for the references of eligible papers, as well as grey literature searches and consultation with experts in the field. Results: From the search, 4 studies were identified which satisfied the inclusion criteria, conducted in a variety of inpatient psychiatric settings, including secure forensic and intellectual disability units and a state psychiatric hospital. There were significant differences in methodological approaches, including the screening tests, diagnostic instruments and diagnostic criteria utilised. Autism spectrum disorder prevalence estimates varied considerably, from 2.4-9.9%. Conclusion: From the limited research data currently available, it appears that the prevalence of autism spectrum disorders is increased in inpatient psychiatric settings relative to the general population. There is a need for further high quality research in this patient group, to add to this limited evidence base, as well as in developing effective strategies to identify patients with a high likelihood of autism spectrum disorders within this setting.
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Affiliation(s)
- Samuel Tromans
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Verity Chester
- Priory Group, Norwich, Norfolk, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Reza Kiani
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Regi Alexander
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, United Kingdom.,Hertfordshire Partnership University NHS Foundation Trust, Broadland Clinic & Astley Court, Norwich, United Kingdom
| | - Terry Brugha
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, Leicestershire, United Kingdom
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509
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Bishop-Fitzpatrick L, Dababnah S, Baker-Ericzén MJ, Smith MJ, Magaña SM. Autism spectrum disorder and the science of social work: A grand challenge for social work research. SOCIAL WORK IN MENTAL HEALTH 2018; 17:73-92. [PMID: 31105472 PMCID: PMC6521880 DOI: 10.1080/15332985.2018.1509411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The social work profession has not yet taken a leadership role in addressing the myriad of challenges that individuals on the autism spectrum encounter across the lifespan. In this essay, we argue that social workers are well equipped to engage in research and practice aimed at promoting full and meaningful inclusion in society, as well as social and economic justice, for individuals on the autism spectrum. We highlight short- and long-term goals that provide the social work profession with a framework to engage in research, practice, education, and advocacy aimed at supporting individuals on the autism spectrum and their families.
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Affiliation(s)
| | | | - Mary J. Baker-Ericzén
- Child and Adolescent Services Research Center at Rady Children’s Hospital, San Diego, CA, USA
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510
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Stacey TL, Froude EH, Trollor J, Foley KR. Leisure participation and satisfaction in autistic adults and neurotypical adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:993-1004. [PMID: 30132680 DOI: 10.1177/1362361318791275] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leisure participation is important for well-being and has been attributed to improved quality of life for autistic individuals. Rigorous studies exploring the leisure participation of autistic adults are sparse. This study aimed to compare the type of leisure activity and frequency of participation between autistic adults and neurotypical adults as well as compare and identify factors associated with their leisure satisfaction. Data for 145 autistic and 104 neurotypical adults were obtained from time point one of the Australian Longitudinal Study of Adults with Autism. The primary outcome measure used was the Leisure Satisfaction Scale. Autistic adults were less satisfied with their leisure overall (mean = 3.29, standard deviation = 0.75) compared with neurotypical adults (mean = 3.69, standard deviation = 0.55). Multiple linear regression revealed being younger and reporting less depressive symptoms were significantly associated with higher leisure satisfaction in autistic but not neurotypical adults. Engagement in solitary leisure activities was comparable across participants, but socialising in person was predominated by neurotypical adults. Leisure activity preferences of autistic adults' and the frequency of their leisure participation are important factors for clinicians to understand when working with this population and tailoring well-being interventions.
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Affiliation(s)
| | | | - Julian Trollor
- 2 UNSW, Australia.,3 Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Kitty-Rose Foley
- 2 UNSW, Australia.,3 Cooperative Research Centre for Living with Autism (Autism CRC), Australia.,4 Southern Cross University, Australia
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511
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Rai D, Heuvelman H, Dalman C, Culpin I, Lundberg M, Carpenter P, Magnusson C. Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood. JAMA Netw Open 2018; 1:e181465. [PMID: 30646131 PMCID: PMC6324523 DOI: 10.1001/jamanetworkopen.2018.1465] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Depression is a frequently occurring mental disorder and may be common in adults with autism spectrum disorders (ASD), but there is a lack of longitudinal population-based studies examining this association. Whether any increased risk of depression in ASD has a shared familial basis and whether it differs by co-occurring intellectual disability is not well known. OBJECTIVES To examine whether individuals with ASD are more likely to be diagnosed as having depression in adulthood than the general population and their nonautistic siblings and to investigate whether these risks differ by the presence or absence of intellectual disability. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study with a nested sibling comparison. The Stockholm Youth Cohort is a total population record linkage study that includes all children and young people (age range, 0-17 years) who were ever resident in Stockholm County, Sweden, between January 2001 and December 2011 (n = 735 096). Data analysis was conducted between January 5 and November 30, 2017, in Stockholm County, Sweden. MAIN OUTCOMES AND MEASURES Clinical diagnosis of depressive disorders was identified using the Stockholm County Adult Psychiatric Outpatient Register and the Swedish National Patient Register. RESULTS Participants were 223 842 individuals followed up to age 27 years by 2011, of whom 4073 had diagnosed ASD (mean [SD] age, 21.5 [2.7] years; 65.9% male; 2927 without intellectual disability and 1146 with intellectual disability) and 219 769 had no ASD (mean [SD] age, 22.1 [2.8] years; 50.9% male). By age 27 years, 19.8% (n = 808) of individuals diagnosed having ASD had a diagnosis of depression compared with 6.0% (n = 13 114) of the general population (adjusted relative risk [RR], 3.64; 95% CI, 3.41-3.88). The risk of a depression diagnosis was higher in ASD without intellectual disability (adjusted RR, 4.28; 95% CI, 4.00-4.58) than in ASD with intellectual disability (adjusted RR, 1.81; 95% CI, 1.51-2.17). Nonautistic full-siblings (adjusted RR, 1.37; 95% CI, 1.23-1.53) and half-siblings (adjusted RR, 1.42; 95% CI, 1.23-1.64) of individuals with ASD also had a higher risk of depression than the general population. Compared with their nonautistic full-siblings, individuals with ASD had more than a 2-fold risk of a depression diagnosis (adjusted odds ratio, 2.50; 95% CI, 1.91-3.27) in young adulthood. CONCLUSIONS AND RELEVANCE According to this study's results, ASD, particularly ASD without intellectual disability, is associated with depression by young adulthood compared with the general population. It appears that this association is unlikely to be explained by shared familial liability. Future research to identify modifiable pathways between ASD and depression may assist in the development of preventive interventions.
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Affiliation(s)
- Dheeraj Rai
- National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Hein Heuvelman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Peter Carpenter
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
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512
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Bileviciute-Ljungar I, Maroti D, Bejerot S. Patients with chronic fatigue syndrome do not score higher on the autism-spectrum quotient than healthy controls: Comparison with autism spectrum disorder. Scand J Psychol 2018; 59:428-432. [DOI: 10.1111/sjop.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/14/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Indre Bileviciute-Ljungar
- Department of Clinical Sciences; Danderyd University Hospital; Karolinska Institutet; and ME/CFS-rehabilitation, Department of Rehabilitation Medicine; Danderyd University Hospital; Stockholm Sweden
- ME/CFS-unit; Pain and Rehabilitation Center; Region Östergotland; Linköping Sweden
| | - Daniel Maroti
- Department of Clinical Sciences; Danderyd University Hospital; Karolinska Institutet; and ME/CFS-rehabilitation, Department of Rehabilitation Medicine; Danderyd University Hospital; Stockholm Sweden
| | - Susanne Bejerot
- Department of Medical Sciences; Örebro University; Örebro Sweden
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513
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Bishop-Fitzpatrick L, Movaghar A, Greenberg JS, Page D, DaWalt LS, Brilliant MH, Mailick MR. Using machine learning to identify patterns of lifetime health problems in decedents with autism spectrum disorder. Autism Res 2018; 11:1120-1128. [PMID: 29734508 PMCID: PMC6203659 DOI: 10.1002/aur.1960] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/16/2018] [Accepted: 04/09/2018] [Indexed: 12/30/2022]
Abstract
Very little is known about the health problems experienced by individuals with autism spectrum disorder (ASD) throughout their life course. We retrospectively analyzed diagnostic codes associated with de-identified electronic health records using a machine learning algorithm to characterize diagnostic patterns in decedents with ASD and matched decedent community controls. Participants were 91 decedents with ASD and 6,186 sex and birth year matched decedent community controls who had died since 1979, the majority of whom were middle aged or older adults at the time of their death. We analyzed all ICD-9 codes, V-codes, and E-codes available in the electronic health record and Elixhauser comorbidity categories associated with those codes. Diagnostic patterns distinguished decedents with ASD from decedent community controls with 75% sensitivity and 94% specificity solely based on their lifetime ICD-9 codes, V-codes, and E-codes. Decedents with ASD had higher rates of most conditions, including cardiovascular disease, motor problems, ear problems, urinary problems, digestive problems, side effects from long-term medication use, and nonspecific lab tests and encounters. In contrast, decedents with ASD had lower rates of cancer. Findings suggest distinctive lifetime diagnostic patterns among decedents with ASD and highlight the need for more research on health outcomes across the lifespan as the population of individuals with ASD ages. As a large wave of individuals with ASD diagnosed in the 1990s enters adulthood and middle age, knowledge about lifetime health problems will become increasingly important for care and prevention efforts. Autism Res 2018, 11: 1120-1128. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study looked at patterns of lifetime health problems to find differences between people with autism who had died and community controls who had died. People with autism had higher rates of most health problems, including cardiovascular, urinary, respiratory, digestive, and motor problems, in their electronic health records. They also had lower rates of cancer. More research is needed to understand these potential health risks as a large number of individuals with autism enter adulthood and middle age.
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Affiliation(s)
- Lauren Bishop-Fitzpatrick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison WI 53705
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706
| | - Arezoo Movaghar
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison WI 53705
| | - Jan S. Greenberg
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison WI 53705
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706
| | - David Page
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI 53792
| | - Leann S. DaWalt
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison WI 53705
| | - Murray H. Brilliant
- Marshfield Clinic Research Institute, 1000 N. Oak Ave., Marshfield, WI 54449
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison WI 53705
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706
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514
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Abstract
Background Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. Methods Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. Results A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. Conclusions Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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515
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Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism 2018; 9:42. [PMID: 30083306 DOI: 10.1186/s13229-018-02264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/22/2018] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. METHODS Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. RESULTS A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. CONCLUSIONS Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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Affiliation(s)
- Sarah Cassidy
- 1School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD UK
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Louise Bradley
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
| | - Rebecca Shaw
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Simon Baron-Cohen
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
- 5Cambridge Lifetime Asperger Syndrome Service (CLASS), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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516
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Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Candon MK, Xie M, Mandell DS. Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder. Health Aff (Millwood) 2018; 36:1754-1761. [PMID: 28971920 DOI: 10.1377/hlthaff.2017.0515] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008-12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.
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Affiliation(s)
- Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research, in Baltimore, Maryland
| | - Andrew J Epstein
- Andrew J. Epstein is scientific director of Medicus Economics, in Philadelphia, Pennsylvania
| | - Steven C Marcus
- Steven C. Marcus is a research associate professor in the School of Social Policy and Practice, University of Pennsylvania, in Philadelphia
| | - Alene Kennedy-Hendricks
- Alene Kennedy-Hendricks is an assistant scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Molly K Candon
- Molly K. Candon is a postdoctoral fellow at the Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
| | - Ming Xie
- Ming Xie is a data analyst at the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
| | - David S Mandell
- David S. Mandell is director of the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
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517
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Cai RY, Richdale AL, Uljarević M, Dissanayake C, Samson AC. Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Res 2018; 11:962-978. [PMID: 29979494 DOI: 10.1002/aur.1968] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/04/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
Emotion dysregulation is a common issue experienced by individuals with autism spectrum disorder (ASD) and has been associated with a wide range of negative mental and physical health outcomes. This commentary highlights the role emotion dysregulation plays in ASD by first considering the literature on emotion regulation (ER) in the general population and then summarizing the ER research in ASD. Based on the evaluation of previous research findings, we conclude that individuals with ASD have more ER difficulties and consistently self-report or demonstrate a less adaptive pattern of ER strategy use. In addition, the higher prevalence of internalizing and externalizing issues seen in ASD are associated with the greater habitual use of some ER strategies and less habitual use of others. Conceptual and methodological limitations are discussed, including the use of coping measures and single-method approaches, and ASD gender distribution. We propose a set of new directions for investigating ER in ASD, incorporating knowledge from other literatures on the role of flexibility in healthy adaptation, overlaps between flexibility and executive function deficits, the adaptive value of up-regulation of positive emotions, and the importance of emotional self-awareness. Increasing our capacity for identifying the mechanisms underlying co-morbid affective disorders can ultimately inform the design of effective interventions to maximize the wellbeing of individuals with ASD. Autism Res 2018, 11: 962-978. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Research has shown that people diagnosed with autism tend to have difficulties with regulating their own emotions. This commentary article summarizes the main information from emotion regulation research conducted both in autism and in other populations. We make suggestions on how we can improve emotion regulation research in autism, with the ultimate goal being to use the learning gained from research to design effective interventions that can improve the wellbeing of people with autism.
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Affiliation(s)
- Ru Ying Cai
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, 3086, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, 3086, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, 3086, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, 3086, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Andrea C Samson
- Swiss Center for Affective Sciences, University of Geneva, Campus Biotech, Chemin des Mines 9, Geneva, 1202, Switzerland.,Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305.,Swiss Distance Learning University, Brig, Switzerland, Überlandstrasse 12, Brig, 3900, Switzerland
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518
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Maddox BB, Kang-Yi CD, Brodkin ES, Mandell DS. Treatment Utilization by Adults with Autism and Co-Occurring Anxiety or Depression. RESEARCH IN AUTISM SPECTRUM DISORDERS 2018; 51:32-37. [PMID: 30319709 PMCID: PMC6181232 DOI: 10.1016/j.rasd.2018.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND While a growing body of research suggests that talk therapies can reduce anxiety and depression in adults with autism spectrum disorder (ASD), we know little about what community treatment for these disorders looks like for them. The present study investigated whether treatment utilization differs between adults with and without ASD who have anxiety or depression. METHOD Using Pennsylvania Medicaid claims data, adults aged 18-65 years diagnosed with ASD and depression or anxiety (n = 268) were matched 1:4 to adults with depression or anxiety disorder without ASD (n = 1,072). Chi-square tests and generalized linear models were used to estimate differences in diagnoses and psychiatric treatment between groups. RESULTS While the proportion of people prescribed benzodiazepine and antidepressants did not differ between groups, the ASD group had more days per month prescribed for all medications. Adults with ASD also were more likely to be prescribed multiple medications concurrently and to use case management. Adults without ASD were more likely to receive talk therapy for anxiety/depression. Among those receiving talk therapy, adults with ASD averaged more individual visits per month. CONCLUSIONS Findings suggest that therapists may need more session time for adults with ASD, although it is unclear if this time is dedicated to anxiety or depression treatment. The greater use of psychotropic medications among adults with ASD may suggest unresponsiveness to the talk therapy they receive or greater clinical complexity.
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Affiliation(s)
- Brenna B. Maddox
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Christina D. Kang-Yi
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Edward S. Brodkin
- Center for Neurobiology and Behavior, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - David S. Mandell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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519
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The Gap Between Adaptive Behavior and Intelligence in Autism Persists into Young Adulthood and is Linked to Psychiatric Co-morbidities. J Autism Dev Disord 2018; 47:3007-3017. [PMID: 28710532 DOI: 10.1007/s10803-017-3213-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
For individuals with autism spectrum disorder (ASD), long-term outcomes have been troubling, and intact IQ has not been shown to be protective. Nevertheless, relatively little research into adaptive functioning among adults with ASD has been completed to date. Therefore, both adaptive functioning and comorbid psychopathology were assessed among 52 adults with ASD without intellectual disability (ID). Adaptive functioning was found to substantially lag behind IQ, and socialization was a particular weakness. Comorbid psychopathology was significantly correlated with the size of IQ-adaptive functioning discrepancy. These findings emphasize key intervention targets of both adaptive skill and psychopathology for transition-age youth and young adults with ASD, as well as the need for ongoing monitoring of anxiety and depression symptoms during this developmental window.
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520
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Cashin A, Yorke J. The Relationship between Anxiety, External Structure, Behavioral History and Becoming Locked into Restricted and Repetitive Behaviors in Autism Spectrum Disorder. Issues Ment Health Nurs 2018; 39:533-537. [PMID: 29436876 DOI: 10.1080/01612840.2017.1418035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Restricted and repetitive behaviors (RRBs) are central to the diagnosis of autism spectrum disorder (ASD), yet there remains a paucity of research in this domain. What is clear is that people with ASD are vulnerable to getting locked into rigid patterns of thought and behavior that contribute to a lack of adaptation. This study utilized an online survey to explore the relationship between anxiety, external structure, the measurement of RRBs and behavioral history of being locked into RRBs. A significant relationship was identified between level of anxiety and a history of becoming locked into RRBs. The likelihood of becoming locked into RRBs increased at times of decreased external structure in the routine of people with ASD.
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Affiliation(s)
- Andrew Cashin
- a Southern Cross University, School of Health and Human Sciences , Lismore , New South Wales , Australia
| | - James Yorke
- b Institute for Physical Science and Technology, University of Maryland , College Park, MD , USA
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521
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The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions. J Autism Dev Disord 2018; 47:2703-2709. [PMID: 28589494 DOI: 10.1007/s10803-017-3188-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), Module 4 is considered a "gold-standard" instrument for diagnosing autism spectrum disorder (ASD) in adults. Although the ADOS-2 shows good sensitivity and specificity in lab-based settings, it is unknown whether these results hold in community clinics that serve a more psychiatrically impaired population. This study is the first to evaluate the diagnostic accuracy of the ADOS-2 among adults in community mental health centers (n = 75). The ADOS-2 accurately identified all adults with ASD; however, it also had a high rate of false positives among adults with psychosis (30%). Findings serve as a reminder that social communication difficulties measured by the ADOS-2 are not specific to ASD, particularly in clinically complex settings.
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522
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Cai RY, Richdale AL, Dissanayake C, Trollor J, Uljarević M. Emotion regulation in autism: Reappraisal and suppression interactions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:737-749. [PMID: 29792076 DOI: 10.1177/1362361318774558] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Emotion regulation has been proposed to be a transdiagnostic factor in the development and maintenance of psychopathology in the general population, yet the nature of the relationships between emotion regulation strategy use and psychological well-being has not been comprehensively explored in individuals with autism spectrum disorder (ASD). The aim of this study was to assess how the individual differences in self-reported emotion regulation strategy use relate to levels of both positive and negative psychological well-being. In total, 56 individuals with ASD aged 14-24 years (Mage = 18.15; SDage = 2.30) completed Emotion Regulation Questionnaire, Diagnostic and Statistical Manual of Mental Disorders-5 Generalized Anxiety Disorder Dimensional Scale, Patient Health Questionnaire-9, Warwick-Edinburgh Mental Well-being Scale and Autism-Spectrum Quotient - Short. Individuals were grouped into four clusters based on their Emotion Regulation Questionnaire subscale scores. Individuals in the high suppression and low reappraisal group expressed higher depressive symptoms and lower positive well-being when compared with the low suppression and high reappraisal group. Interestingly, individuals who self-reported using both high suppression and reappraisal expressed relatively high positive well-being and low depression symptoms. We suggest that the maladaptive effect of habitual suppression usage may be buffered by the habitual use of reappraisal, and this interaction between adaptive and maladaptive emotion regulation strategy use has clinical implications.
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Affiliation(s)
- Ru Ying Cai
- 1 The Olga Tennison Autism Research Centre, La Trobe University, Australia.,2 Cooperative Research Centre for Living with Autism, Australia
| | - Amanda L Richdale
- 1 The Olga Tennison Autism Research Centre, La Trobe University, Australia.,2 Cooperative Research Centre for Living with Autism, Australia
| | - Cheryl Dissanayake
- 1 The Olga Tennison Autism Research Centre, La Trobe University, Australia.,2 Cooperative Research Centre for Living with Autism, Australia
| | - Julian Trollor
- 2 Cooperative Research Centre for Living with Autism, Australia.,3 UNSW Sydney, Australia
| | - Mirko Uljarević
- 1 The Olga Tennison Autism Research Centre, La Trobe University, Australia.,2 Cooperative Research Centre for Living with Autism, Australia.,4 Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, USA
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523
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Moseley RL, Hitchiner R, Kirkby JA. Self-reported sex differences in high-functioning adults with autism: a meta-analysis. Mol Autism 2018; 9:33. [PMID: 29796237 PMCID: PMC5960195 DOI: 10.1186/s13229-018-0216-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences in autistic symptomatology are believed to contribute to the mis- and missed diagnosis of many girls and women with an autism spectrum condition (ASC). Whilst recent years have seen the emergence of clinical and empirical reports delineating the profile of young autistic girls, recognition of sex differences in symptomatology in adulthood is far more limited. Methods We chose here to focus on symptomatology as reported using a screening instrument, the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R). In a meta-analysis, we pooled and analysed RAADS-R data from a number of experimental groups. Analysis of variance (ANOVA) searched for the presence of main effects of Sex and Diagnosis and for interactions between these factors in our sample of autistic and non-autistic adults. Results In social relatedness and circumscribed interests, main effects of Diagnosis revealed that as expected, autistic adults reported significantly greater lifetime prevalence of symptoms in these domains; an effect of Sex, in circumscribed interests, also suggested that males generally reported more prevalent symptoms than females. An interaction of Sex and Diagnosis in language symptomatology revealed that a normative sex difference in language difficulties was attenuated in autism. An interaction of Sex and Diagnosis in the sensorimotor domain revealed the opposite picture: a lack of sex differences between typically developing men and women and a greater prevalence of sensorimotor symptoms in autistic women than autistic men. Conclusions We discuss the literature on childhood sex differences in relation to those which emerged in our adult sample. Where childhood sex differences fail to persist in adulthood, several interpretations exist, and we discuss, for example, an inherent sampling bias that may mean that only autistic women most similar to the male presentation are diagnosed. The finding that sensorimotor symptomatology is more highly reported by autistic women is a finding requiring objective confirmation, given its potential importance in diagnosis. Electronic supplementary material The online version of this article (10.1186/s13229-018-0216-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R L Moseley
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - R Hitchiner
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - J A Kirkby
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
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524
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Healy S, Nacario A, Braithwaite RE, Hopper C. The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Autism Res 2018; 11:818-833. [DOI: 10.1002/aur.1955] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 02/06/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Sean Healy
- Department of Behavioral Health and Nutrition; University of Delaware; Newark Delaware
| | - Adam Nacario
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
| | - Rock E. Braithwaite
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
| | - Chris Hopper
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
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525
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Maddox BB, Gaus VL. Community Mental Health Services for Autistic Adults: Good News and Bad News. AUTISM IN ADULTHOOD 2018; 1:15-19. [PMID: 31667466 DOI: 10.1089/aut.2018.0006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many autistic adults experience psychiatric conditions such as anxiety and depression. However, autistic adults often do not receive effective and affordable mental health (MH) treatment. Untreated psychiatric conditions in autistic adults are associated with a host of negative outcomes, including adaptive functioning impairments, difficulties with employment and independent living, and poor quality of life. The purpose of this Perspectives piece is to shed light on the current state of community MH services in the United States for autistic adults with co-occurring psychiatric conditions. Drawing on the available research and clinical experiences, we aim to (1) highlight positive developments in community mental healthcare for autistic adults; (2) summarize the barriers that continue to exist for autistic adults in need of MH services; and (3) provide recommendations for autistic adults and their families, community MH clinicians, and MH systems administrators to consider. Significant work is needed to provide autistic adults with affordable quality MH services. This Perspectives piece presents a summary of the needed changes and specific methods to continue to improve community MH services for autistic adults.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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526
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Baumgartner C, Fan D, Fang MC, Singer DE, Witt DM, Schmelzer JR, Williams MS, Gurwitz JH, Sung SH, Go AS. Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study. J Am Heart Assoc 2018; 7:e007814. [PMID: 29656278 PMCID: PMC6015441 DOI: 10.1161/jaha.117.007814] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/14/2018] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anxiety and depression are associated with worse outcomes in several cardiovascular conditions, but it is unclear whether they affect outcomes in atrial fibrillation (AF). In a large diverse population of adults with AF, we evaluated the association of diagnosed anxiety and/or depression with stroke and bleeding outcomes. METHODS AND RESULTS The Cardiovascular Research Network WAVE (Community-Based Control and Persistence of Warfarin Therapy and Associated Rates and Predictors of Adverse Clinical Events in Atrial Fibrillation and Venous Thromboembolism) Study included adults with AF newly starting warfarin between 2004 and 2007 within 5 health delivery systems in the United States. Diagnosed anxiety and depression and other patient characteristics were identified from electronic health records. We identified stroke and bleeding outcomes from hospitalization databases using validated International Classification of Diseases, Ninth Revision (ICD-9), codes. We used multivariable Cox regression to assess the relation between anxiety and/or depression with outcomes after adjustment for stroke and bleeding risk factors. In 25 570 adults with AF initiating warfarin, 490 had an ischemic stroke or intracranial hemorrhage (1.52 events per 100 person-years). In multivariable analyses, diagnosed anxiety was associated with a higher adjusted rate of combined ischemic stroke and intracranial hemorrhage (hazard ratio, 1.52; 95% confidence interval, 1.01-2.28). Results were not materially changed after additional adjustment for patient-level percentage of time in therapeutic anticoagulation range on warfarin (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36). In contrast, neither isolated depression nor combined depression and anxiety were significantly associated with outcomes. CONCLUSIONS Diagnosed anxiety was independently associated with increased risk of combined ischemic stroke and intracranial hemorrhage in adults with AF initiating warfarin that was not explained by differences in risk factors or achieved anticoagulation quality.
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Affiliation(s)
- Christine Baumgartner
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA
- Department of General Internal Medicine, Inselspital Bern, Bern University Hospital University of Bern, Switzerland
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Daniel M Witt
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - John R Schmelzer
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, WI
| | - Marc S Williams
- Genomic Medicine Institute, Weis Center for Research, Geisinger, Danville, PA
| | - Jerry H Gurwitz
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
- Meyers Primary Care Institute, Worcester, MA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Departments of Epidemiology #x0026; Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA
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527
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Tolchard B, Stuhlmiller C. Chronic health and lifestyle problems for people diagnosed with autism in a student-led clinic. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-01-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose
People with autism spectrum disorder (ASD) are at greater risk of developing chronic health and risky lifestyle problems. This is exaggerated further for people living in rural settings and from cultural backgrounds traditionally underserved by healthcare services. The purpose of this paper is to describe an evaluation of health and behavioural lifestyle outcomes of people diagnosed with ASD in a student-led clinic in rural/regional Australia.
Design/methodology/approach
Routine clinical outcomes and lifestyle measures were routinely collected at a primary acre student-led Clinic in rural/regional Australia. Participants were all attending the clinic who provided consent for their routine date to be reported. Participants ranged in age from new born to 100 years and were representative of the local community.
Findings
The results indicate there is an increased risk for people with ASD developing chronic conditions compared to those without a diagnosis. This also resulted in higher body mass index and blood sugar levels linked to diabetes and hypertension. Mental health problems were common in people diagnosed with ASD especially anxiety disorders. Smoking was problematic for people with ASD but mainly in non-Aboriginal and Torres Strait Islanders. Alcohol use was not an increase risk in ASD.
Originality/value
Little is reported on the health and lifestyle experiences of people with ASD in rural/regional settings, especially from Aboriginal and Torres Strait Islander communities. This paper gives an initial insight to the presentation of chronic conditions and harmful lifestyle choices. Possible insights into adapting or modifying care for people with ASD in rural/regional Australia are given.
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528
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Davignon MN, Qian Y, Massolo M, Croen LA. Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD. Pediatrics 2018; 141:S335-S345. [PMID: 29610415 DOI: 10.1542/peds.2016-4300k] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. METHODS Participants included Kaiser Permanente Northern California members who were enrolled from 2013 to 2015 and who were 14 to 25 years old. Individuals with ASD (n = 4123) were compared with peers with attention-deficit/hyperactivity disorder (n = 20 615), diabetes mellitus (n = 2156), and typical controls with neither condition (n = 20 615). RESULTS Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. After controlling for sex, age, race, and duration of Kaiser Permanente Northern California membership, most psychiatric conditions were significantly more common in the ASD group than in each comparison group, and most medical conditions were significantly more common in the ASD group than in the attention-deficit/hyperactivity disorder and typical control groups but were similar to or significantly less common than the diabetes mellitus group. CONCLUSIONS Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues.
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Affiliation(s)
- Meghan N Davignon
- Department of Pediatrics, The Permanente Medical Group, Inc, Oakland, California; .,Kaiser Permanente Roseville Medical Center, Roseville, California; and
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Maria Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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529
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Vuijk R, Deen M, Sizoo B, Arntz A. Temperament, Character, and Personality Disorders in Adults with Autism Spectrum Disorder: a Systematic Literature Review and Meta-analysis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0131-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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530
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Mandell D. Dying before their time: Addressing premature mortality among autistic people. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018. [DOI: 10.1177/1362361318764742] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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531
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Cashin A, Buckley T, Trollor JN, Lennox N. A scoping review of what is known of the physical health of adults with autism spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2018; 22:96-108. [PMID: 27623754 DOI: 10.1177/1744629516665242] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little research has been carried out on the physical health of people with autism spectrum disorder (ASD). From the studies conducted with both children and adults, few studies have moved beyond retrospective record analysis and survey and conducted health assessment. The majority of the studies are from the United States of America with a small number conducted in Europe. A scoping review was conducted to determine what is known of the physical health of adults with ASD and to identify research gaps. In addition to studies of adults, this review includes studies of children to determine possible health trajectories. From the findings, it can be stated with confidence that people with ASD have a high rate of comorbidity and increased risk for chronic disease.
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532
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Kennedy-Hendricks A, Epstein AJ, Mandell DS, Candon MK, Marcus SC, Xie M, Barry CL. Effects of State Autism Mandate Age Caps on Health Service Use and Spending Among Adolescents. J Am Acad Child Adolesc Psychiatry 2018; 57:125-131. [PMID: 29413145 PMCID: PMC5806145 DOI: 10.1016/j.jaac.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many states with mandates requiring commercial insurers to cover autism spectrum disorder (ASD) health services specify upper age limits above which coverage is no longer mandated. It is unknown what effects these age caps have on health service use and spending among adolescents who have exceeded the age cap. METHOD Using administrative claims data from 3 national commercial insurers, a difference-in-differences approach was used to estimate effects of age caps on health service use and spending among adolescents with ASD. Statistical models compared changes in use and spending between those above versus below the age cap among individuals eligible versus ineligible for mandated coverage. The analytic sample included data from 2008 through 2012 on 7,845 individuals (151,976 person-months) ages 10 to 21 years in 11 states imposing mandate age caps going into effect during adolescence. RESULTS Age caps were associated with 4.2 percentage point (95% CI = -7.0, -1.5) lower probability of any ASD-specific service use in a month and $69 less (95% CI = -112, -$26) in average monthly spending on ASD-specific services than would have been expected given concomitant pre-post age cap differences among individuals in the same states who were never eligible for mandate-covered services. In addition, age caps were associated with $99 (95% CI = -$168, -$30) lower average monthly spending on all health care services. CONCLUSION Insurance mandates that include age caps going into effect during adolescence reduce health service use and spending among individuals with ASD during a critical phase of the life course.
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Affiliation(s)
| | | | - David S Mandell
- Leonard Davis Institute of Health Economics, Philadelphia; Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Molly K Candon
- Leonard Davis Institute of Health Economics, Philadelphia
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Ming Xie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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533
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Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0133-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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534
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Valiente-Pallejà A, Torrell H, Muntané G, Cortés MJ, Martínez-Leal R, Abasolo N, Alonso Y, Vilella E, Martorell L. Genetic and clinical evidence of mitochondrial dysfunction in autism spectrum disorder and intellectual disability. Hum Mol Genet 2018; 27:891-900. [DOI: 10.1093/hmg/ddy009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/30/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Alba Valiente-Pallejà
- Research Department, Hospital Universitari Institut Pere Mata, E43206 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
| | | | - Gerard Muntané
- Research Department, Hospital Universitari Institut Pere Mata, E43206 Reus, Spain
- Institute of Evolutionary Biology, Spanish National Research Council (CSIC), Universitat Pompeu Fabra, E08003 Barcelona, Catalonia, Spain
| | - Maria J Cortés
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
- Intellectual Disability-Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, E43204 Reus, Catalonia, Spain
- Facultat de Medicina i CIències de la Salut, Universitat Rovira i Virgili (URV), E43201 Reus, Catalonia, Spain
| | - Rafael Martínez-Leal
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
- Intellectual Disability-Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, E43204 Reus, Catalonia, Spain
- Facultat de Medicina i CIències de la Salut, Universitat Rovira i Virgili (URV), E43201 Reus, Catalonia, Spain
| | - Nerea Abasolo
- Center for Omic Sciences, 43204 Reus, Catalonia, Spain
| | - Yolanda Alonso
- Research Department, Hospital Universitari Institut Pere Mata, E43206 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
- Facultat de Medicina i CIències de la Salut, Universitat Rovira i Virgili (URV), E43201 Reus, Catalonia, Spain
| | - Elisabet Vilella
- Research Department, Hospital Universitari Institut Pere Mata, E43206 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
- Facultat de Medicina i CIències de la Salut, Universitat Rovira i Virgili (URV), E43201 Reus, Catalonia, Spain
| | - Lourdes Martorell
- Research Department, Hospital Universitari Institut Pere Mata, E43206 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), E43204 Reus, Catalonia, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), E43204 Reus, Catalonia, Spain
- Facultat de Medicina i CIències de la Salut, Universitat Rovira i Virgili (URV), E43201 Reus, Catalonia, Spain
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535
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Amaral DG, Anderson MP, Ansorge O, Chance S, Hare C, Hof PR, Miller M, Nagakura I, Pickett J, Schumann C, Tamminga C. Autism BrainNet: A network of postmortem brain banks established to facilitate autism research. HANDBOOK OF CLINICAL NEUROLOGY 2018; 150:31-39. [PMID: 29496150 DOI: 10.1016/b978-0-444-63639-3.00003-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Autism spectrum disorder (ASD or autism) is a neurodevelopmental condition that affects over 1% of the population worldwide. Developing effective preventions and treatments for autism will depend on understanding the genetic perturbations and underlying neuropathology of the disorder. While evidence from magnetic resonance imaging and other noninvasive techniques points to altered development and organization of the autistic brain, these tools lack the resolution for identifying the cellular and molecular underpinnings of the disorder. Postmortem studies of high-quality human brain tissue currently represent the only viable option to pursuing these types of studies. However, the availability of high-quality ASD brain tissue has been extremely limited. Here we describe the establishment of a privately funded tissue bank, Autism BrainNet, a network of brain collection sites that work in a coordinated fashion to develop an adequate library of human postmortem brain tissues. Autism BrainNet was initiated as a collaboration between the Simons Foundation and Autism Speaks, and is currently funded by the Simons Foundation Autism Research Initiative. Autism BrainNet has collection sites (nodes) in California, Texas, New York, and Massachusetts; an affiliated, international node is located in Oxford, England. All donations to this network become part of a consolidated pool of tissue that is distributed to qualified investigators worldwide to carry out autism research. An essential component of this program is a widespread outreach program that highlights the need for postmortem brain donations to families affected by autism, led by the Autism Science Foundation. Challenges include an outreach campaign that deals with a disorder beginning in early childhood, collecting an adequate number of donations to deal with the high level of biologic heterogeneity of autism, and preparing this limited resource for optimal distribution to the greatest number of investigators.
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Affiliation(s)
- David G Amaral
- The MIND Institute, University of California at Davis, Sacramento, CA, United States.
| | - Matthew P Anderson
- Department of Neurology and Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, Academic Unit of Neuropathology, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Steven Chance
- Nuffield Department of Clinical Neurosciences, Academic Unit of Neuropathology, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Carolyn Hare
- Autism BrainNet, Foundation Associates, New York, NY, United States
| | - Patrick R Hof
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Melissa Miller
- The MIND Institute, University of California at Davis, Sacramento, CA, United States
| | - Ikue Nagakura
- The MIND Institute, University of California at Davis, Sacramento, CA, United States
| | - Jane Pickett
- Autism BrainNet, Foundation Associates, New York, NY, United States
| | - Cynthia Schumann
- The MIND Institute, University of California at Davis, Sacramento, CA, United States
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern, Dallas, TX, United States
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536
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Howes OD, Rogdaki M, Findon JL, Wichers RH, Charman T, King BH, Loth E, McAlonan GM, McCracken JT, Parr JR, Povey C, Santosh P, Wallace S, Simonoff E, Murphy DG. Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol 2018; 32:3-29. [PMID: 29237331 PMCID: PMC5805024 DOI: 10.1177/0269881117741766] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.
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Affiliation(s)
- Oliver D Howes
- 1 MRC London Institute of Medical Sciences, London, UK
- 2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Rogdaki
- 1 MRC London Institute of Medical Sciences, London, UK
| | - James L Findon
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Robert H Wichers
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Tony Charman
- 4 Department of Psychology, King's College London, London UK
| | - Bryan H King
- 5 Department of Psychiatry, University of California at San Francisco, San Francisco, USA
| | - Eva Loth
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Gráinne M McAlonan
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - James T McCracken
- 8 Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, USA
| | - Jeremy R Parr
- 9 Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carol Povey
- 10 The National Autistic Society, London, UK
| | - Paramala Santosh
- 11 Department of Child Psychiatry, King's College London, London, UK
| | | | - Emily Simonoff
- 13 Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Declan G Murphy
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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537
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Hamm J, Yun J. Influence of physical activity on the health-related quality of life of young adults with and without autism spectrum disorder. Disabil Rehabil 2017; 41:763-769. [DOI: 10.1080/09638288.2017.1408708] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Hamm
- Department of Exercise Science, Georgia Gwinnett College, Lawrenceville, GA, USA
| | - Joonkoo Yun
- Department of Kinesiology, Oregon State University, Corvallis, OR, USA
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538
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Abstract
Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high quality care delivery, adequate care access) disparities in ASD. Nine studies met final inclusion criteria. Seven studies identified racial disparities in access to general medical services for children with ASD. No studies examined disparities in health outcomes or included older adults. We present a model of health disparities (Fundamental Causes Model) that guides future research. Additional work should examine health disparities, and their causal pathways, in ASD, particularly for older adults.
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Affiliation(s)
- Lauren Bishop-Fitzpatrick
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
| | - Amy J H Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- VA Geriatrics Research Education and Clinical Center (GRECC), Madison, WI, USA
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539
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Pelton MK, Cassidy SA. Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample. Autism Res 2017; 10:1891-1904. [PMID: 28685996 PMCID: PMC5697632 DOI: 10.1002/aur.1828] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/28/2017] [Accepted: 06/05/2017] [Indexed: 11/08/2022]
Abstract
Autism spectrum conditions (ASC) has recently been associated with increased risk of suicidality. However, no studies have explored how autistic traits may interact with current models of suicidal behavior in a non-clinical population. The current study therefore explored how self-reported autistic traits interact with perceived burdensomeness and thwarted belongingness in predicting suicidal behavior, in the context of the Interpersonal-Psychological Theory of Suicide (IPTS). 163 young adults (aged 18-30 years) completed an online survey including measures of thwarted belonging and perceived burdensomeness (Interpersonal Needs Questionnaire), self-reported autistic traits (Autism Spectrum Quotient), current depression (Centre for Epidemiological Studies Depression Scale), and lifetime suicidality (Suicide Behavior Questionnaire-Revised). Results showed that burdensomeness and thwarted belonging significantly mediated the relationship between autistic traits and suicidal behavior. Both depression and autistic traits significantly predicted thwarted belonging and perceived burdensomeness. Autistic traits did not significantly moderate the relationship between suicidal behavior and thwarted belonging or perceived burdensomeness. Results suggest that the IPTS provides a useful framework for understanding the influence of autistic traits on suicidal behavior. However, the psychometric properties of these measures need be explored in those with clinically confirmed diagnosis of ASC. Autism Res 2017, 10: 1891-1904. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY Recent research has shown that people with high autistic traits are more likely to attempt suicide. However, no studies have explored why. We found that people with high autistic traits were more likely to experience feelings that they do not belong in the world, are a burden on others, and depression, which may increase their likelihood of attempting suicide. These results suggest that promoting inclusion and independence in those with high autistic traits could help prevent people attempting suicide.
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Affiliation(s)
- M. K. Pelton
- Centre for Research in PsychologyBehaviour and Achievement, Coventry UniversityCoventryUK
- School of PsychologyUniversity of BirminghamBirminghamUK
| | - S. A. Cassidy
- Centre for Research in PsychologyBehaviour and Achievement, Coventry UniversityCoventryUK
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540
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Steenbergen L, Colzato LS. Overweight and Cognitive Performance: High Body Mass Index Is Associated with Impairment in Reactive Control during Task Switching. Front Nutr 2017; 4:51. [PMID: 29164126 PMCID: PMC5671535 DOI: 10.3389/fnut.2017.00051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/09/2017] [Indexed: 12/16/2022] Open
Abstract
The prevalence of weight problems is increasing worldwide. There is growing evidence that high body mass index (BMI) is associated with frontal lobe dysfunction and deficits in cognitive control. The present study aims to clarify the association between weight status and the degree of impairment in cognitive flexibility, i.e., the ability to efficiently switch from one task to another, by disentangling the preparatory and residual domains of task switching. Twenty-six normal weight (BMI < 25, five males) and twenty-six overweight (BMI ≥ 25, seven males) university students performed a task-switching paradigm that provides a relatively well-established diagnostic measure of proactive vs. reactive control with regard to cognitive flexibility. Compared to individuals with a BMI lower than 25, overweight (i.e., ≥25) was associated with increased switching costs in the reactive switching condition (i.e., when preparation time is short), representing reduced cognitive flexibility in the preparatory domain. In addition, the overweight group reported significantly more depression and binge eating symptoms, although still indicating minimal depression. No between-group differences were found with regard to self-reported autism spectrum symptoms, impulsiveness, state- and trait anxiety, and cognitive reactivity to depression. The present findings are consistent with and extend previous literature showing that elevated BMI in young, otherwise healthy individuals is associated with significantly more switching costs due to inefficiency in the retrieval, implementation, and maintenance of task sets, indicating less efficient cognitive control functioning.
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Affiliation(s)
- Laura Steenbergen
- Cognitive Psychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Lorenza S Colzato
- Cognitive Psychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.,Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany.,Institute of Sports and Sport Science, University of Kassel, Kassel, Germany
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541
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Examining the Behavioural Sleep-Wake Rhythm in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability. J Autism Dev Disord 2017; 47:1207-1222. [PMID: 28160224 DOI: 10.1007/s10803-017-3042-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to examine the behavioural sleep-wake rhythm in 36 adults with autism spectrum disorder (ASD) and to determine the prevalence of circadian sleep-wake rhythm disorders compared to age- and sex-matched controls. Participants completed an online questionnaire battery, a 14-day sleep-wake diary and 14-day actigraphy assessment. The results indicated that a higher proportion of adults with ASD met criteria for a circadian rhythm sleep-wake disorder compared to control adults. In particular, delayed sleep-wake phase disorder was particularly common in adults with ASD. Overall the findings suggest that individuals with ASD have sleep patterns that may be associated with circadian rhythm disturbance; however factors such as employment status and co-morbid anxiety and depression appear to influence their sleep patterns.
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542
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Hillier A, Galizzi M, Ferrante K. Healthcare experiences of young adults with autism spectrum disorder. ADVANCES IN AUTISM 2017. [DOI: 10.1108/aia-06-2017-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Characteristic challenges that define autism spectrum disorder (ASD), coupled with comorbid conditions and poor communication with providers, can lead to inadequate healthcare. The majority of previous work has focused on children. The purpose of this paper is to examine the healthcare experiences of young adults with ASD within the US healthcare system.
Design/methodology/approach
An online questionnaire was utilized to examine: the accessibility of healthcare for those with ASD: do they make their own appointments, fill out paperwork independently, go in the examination room on their own; the quality of care they receive: what are their medical needs, how effectively can they communicate their needs, do providers understand their disability; and the outcomes of care: do they understand their recommended care, can they follow healthcare instructions accurately, are they satisfied with the care received. The authors compared responses of those with ASD (n=16) with those of parents of adults with ASD (n=50), as well as a matched comparison group of young adults without ASD (n=42) for statistical differences using the Fisher Exact test. The authors also asked parents about their time costs of assisting their adult children through the healthcare process.
Findings
The results suggest that those with ASD overestimated their ability to manage their healthcare needs, felt more positively about the healthcare they received than was warranted, and were significantly less independent in managing their healthcare than their peers. Parents experienced losses and costs in terms of lost productivity, household work, and personal time.
Originality/value
This study furthers the understanding of the healthcare experiences of young adults with ASD which is crucial to dissecting problems which hamper access to quality care.
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543
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Uljarević M, Richdale AL, McConachie H, Hedley D, Cai RY, Merrick H, Parr JR, Le Couteur A. The Hospital Anxiety and Depression scale: Factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism Res 2017; 11:258-269. [PMID: 28922575 DOI: 10.1002/aur.1872] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/25/2017] [Indexed: 12/17/2022]
Abstract
Despite the high frequency of anxiety and depression symptoms in individuals with Autism Spectrum Disorder (ASD) and a significant impact of these comorbidities on both individuals with ASD and their families, research on the validity of anxiety and depression measures in the ASD population is currently lacking. The aim of this study was to explore the psychometric properties of the Hospital Anxiety and Depression Scale [HADS; Zigmond & Snaith, ] in a sample of older adolescents and young adults with ASD. One hundred and fifty one participants (UK Transition longitudinal study: N = 106; 75 males, Mage = 16.04 years, SD = 1.28; Longitudinal Study of Australian Schools Leavers with ASD: N = 45, 30 males; Mage = 18.35 years, SD = 2.55) completed the HADS and a range of mental health and well-being measures. Combination of the Principal Component Analysis and Parallel Analysis indicated two factors as an optimal solution in our sample, accounting for 43.77% of variance with factors being identical in terms of content with the structure found in the general population. Internal consistency was good for the HADS anxiety scale (HADS-A; .82-.84) and acceptable for the HADS depression scale (HADS-D; .60-.72). Convergent validity of both HADS-A and HADS-D scales was excellent and divergent validity was acceptable. Our study represents a significant contribution to the literature by providing an initial validation of the HADS in older adolescents and younger adults with ASD. Autism Res 2018, 11: 258-269. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Research on the validity of measurement of anxiety and depression in ASD is currently lacking. The aim of this study was to explore the properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of 151 young people with ASD. Participants completed HADS and a range of mental health and well-being measures. Encouragingly, our findings suggest that HADS provides a reliable and valid assessment of anxiety and depression in ASD.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
| | - Ru Ying Cai
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Hannah Merrick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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544
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Zheng Z, Zhang L, Li S, Zhao F, Wang Y, Huang L, Huang J, Zou R, Qu Y, Mu D. Association among obesity, overweight and autism spectrum disorder: a systematic review and meta-analysis. Sci Rep 2017; 7:11697. [PMID: 28916794 PMCID: PMC5601947 DOI: 10.1038/s41598-017-12003-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 09/01/2017] [Indexed: 02/07/2023] Open
Abstract
Obesity, overweight and autism spectrum disorder (ASD) remain serious public health problems. Although lots of studies have recently explored the association among obesity, overweight and ASD, the findings are inconsistent. Thus, we conducted a meta-analysis of epidemiological studies to examine the association among obesity, overweight and ASD. PubMed, Embase, and the Cochrane Library were used for literature searches to identify eligible studies published in English before November 15, 2016. Relevant studies estimating the association among obesity, overweight and ASD were included. Fifteen studies encompassing 49,937,078 participants and 1,045,538 individuals with ASD were included in this study. A random effects model was chosen to synthesize the effect sizes of individual studies. The prevalence of obesity was significantly higher in individuals with ASD than in controls (OR = 1.84, 95% confidence interval [CI]: 1.37–2.48, P < 0.001). However, the prevalence of overweight in individuals with ASD was not significantly different from that in controls (OR = 1.07, 95% CI: 0.83–1.38, P = 0.62). Both sensitivity analysis and publication bias testing revealed that the findings were robust. The meta-analysis showed a significant association between obesity and ASD. However, no significant association was identified between overweight and ASD.
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Affiliation(s)
- Zhen Zheng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Shiping Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Fengyan Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Yan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Lan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Rong Zou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China.
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545
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Birch RC, Foley KR, Pollack A, Britt H, Lennox N, Trollor JN. Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:995-1004. [PMID: 28914073 DOI: 10.1177/1362361317714588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder is associated with high rates of co-occurring health conditions. While elevated prescription rates of psychotropic medications have been reported in the United Kingdom and the United States, there is a paucity of research investigating clinical and prescribing practices in Australia. This study describes the problems managed and medications prescribed by general practitioners in Australia during encounters where an autism spectrum disorder was recorded. Information was collected from 2000 to 2014 as part of the Bettering the Evaluation and Care of Health programme. Encounters where patients were aged less than 25 years and autism spectrum disorder was recorded as one of the reasons for encounter and/or problems managed ( n = 579) were compared to all other Bettering the Evaluation and Care of Health programme encounters with patients aged less than 25 years ( n = 281,473). At 'autism spectrum disorder' encounters, there was a significantly higher management rate of psychological problems, and significantly lower management rates of skin, respiratory and general/unspecified problems, than at 'non-autism spectrum disorder' encounters. The rate of psychological medication prescription was significantly higher at 'autism spectrum disorder' encounters than at 'non-autism spectrum disorder' encounters. The most common medications prescribed at 'autism spectrum disorder' encounters were antipsychotics and antidepressants. Primary healthcare providers need adequate support and training to identify and manage physical and mental health concerns among individuals with autism spectrum disorder.
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Affiliation(s)
| | - Kitty-Rose Foley
- 1 UNSW Sydney, Australia.,2 Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | | | | | - Nicholas Lennox
- 2 Cooperative Research Centre for Living with Autism (Autism CRC), Australia.,4 The University of Queensland, Australia
| | - Julian N Trollor
- 1 UNSW Sydney, Australia.,2 Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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546
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Lounds Taylor J. When is a good outcome actually good? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 21:918-919. [DOI: 10.1177/1362361317728821] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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547
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Saqr Y, Braun E, Porter K, Barnette D, Hanks C. Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:51-61. [PMID: 28750547 PMCID: PMC5788079 DOI: 10.1177/1362361317709970] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Little has been reported about how to improve health care access and delivery for adolescents and adults with autism spectrum disorder. To understand the contributions to the health disparities in the autism spectrum disorder population, we conducted two independent research approaches to learn about current medical needs. A retrospective chart review was performed to evaluate medical comorbidities and medication use. A focus group was also created to address barriers faced in providing medical care. Of 126 charts reviewed, 49% (n = 62) had intellectual disability, 49% (n = 62) had attention-deficit hyperactivity disorder, 52% (n = 65) had anxiety, 41% (n = 52) had obesity, 31% (n = 39) with a history of aggressive behavior, 31% (n = 31) had depression, 22% (n = 28) had seizures, and 9% (n = 11) had hypertension. A Medical Regimen Complexity Index score was determined to examine medication use trends in the autism spectrum disorder population. Medical Regimen Complexity Index scores were significantly higher for patients with intellectual disability, patients with seizures, and patients with a history of aggressive behavior. Both the focus group and our pre-visit assessment identified the waiting room and waiting time as barriers to care. Understanding the comorbidities, polypharmacy, and medical barriers should provide a better understanding of the current health care access and delivery needs of adolescents and adults with autism spectrum disorder.
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548
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Lunsky Y, Weiss JA, Paquette-Smith M, Durbin A, Tint A, Palucka AM, Bradley E. Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study. BMJ Open 2017; 7:e017377. [PMID: 28720619 PMCID: PMC5541491 DOI: 10.1136/bmjopen-2017-017377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). DESIGN Prospective cohort study. SETTING Community-based study from Ontario, Canada. PARTICIPANTS Parents reported on their adult sons and daughters with ASD living in the community (n=284). MAIN OUTCOME MEASURES ED visits for any reason, ED visits for medical reasons and ED visits for psychiatric reasons over 1 year. RESULTS Among individuals with ASD, those with ED visits for any reason were reported to have greater family distress at baseline (p<0.01), a history of visiting the ED during the year prior (p<0.01) and experienced two or more negative life events at baseline (p<0.05) as compared with those who did not visit the ED. Unique predictors of medical versus psychiatric ED visits emerged. Low neighbourhood income (p<0.01) and living in a rural neighbourhood (p<0.05) were associated with medical but not psychiatric ED visits, whereas a history of aggression (p<0.05) as well as being from an immigrant family (p<0.05) predicted psychiatric but not medical emergencies. CONCLUSIONS A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population.
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Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Melissa Paquette-Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Anna Durbin
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Research and Evaluation, Canadian Mental Health Association–Toronto Branch, Toronto, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Anna M Palucka
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elspeth Bradley
- Department of Psychiatry, University of Toronto, Toronto, Canada
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549
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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550
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Tint A, Palucka AM, Bradley E, Weiss JA, Lunsky Y. Correlates of Police Involvement Among Adolescents and Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:2639-2647. [DOI: 10.1007/s10803-017-3182-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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