51
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Byrne K, Sterrett K, Elias R, Bal VH, McCauley JB, Lord C. Trajectories of Seizures, Medication Use, and Obesity Status into Early Adulthood in Autistic Individuals and Those with Other Neurodevelopmental Conditions. AUTISM IN ADULTHOOD 2022; 4:110-119. [PMID: 36605975 PMCID: PMC9242707 DOI: 10.1089/aut.2020.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Physical and psychiatric health conditions affect the lives of many autistic adults. However, relatively little is known about individual trajectories in autistic individuals' physical and mental health from adolescence to adulthood. Methods This study uses a well-characterized longitudinal sample (n = 253) to investigate rates of seizures, medication use, and obesity, from early adolescence (age 10 years) into adulthood (age 30 years). Within this sample, 196 participants were diagnosed with autism spectrum disorder (ASD), whereas the remaining 57 participants never received an ASD diagnosis, but, rather, were diagnosed with other neurodevelopmental conditions. Data were collected through parent report questionnaires and in-person interviews and assessments. Results Seizure onset continued well into adulthood, with two individuals experiencing their first seizure at the age of 25 years. Seizures and neuropsychiatric medication use were both higher for those with lower intelligence quotient (IQs). In addition, medication use increased over time for these individuals, whereas those with higher IQs saw a reduction in medication use with age. Between the ages of 15 to 30 years, the predicted probability of medication use increased from 82% to 88% for those with lower IQs and decreased from 37% to 13% for those with higher IQs. Collectively, almost 70% of all participants in this study were classified as either overweight or obese. Body mass index (BMI) increased throughout adulthood, especially for those with higher IQs. The steepest increase in BMI over time occurred for those with higher IQs who also took antipsychotic medications. Conclusion Overall, continued risk for developing seizures, high rates of neuropsychiatric medication use, and significant and increasing rates of obesity from adolescence to adulthood underscore the importance of monitoring health issues in autistic individuals and those diagnosed with other neurodevelopmental conditions throughout the lifespan.
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Affiliation(s)
- Katherine Byrne
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Katherine Byrne, BA, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-217, Los Angeles, CA 90024, USA
| | - Kyle Sterrett
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Rebecca Elias
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Vanessa H. Bal
- Graduate School of Applied and Professional Psychology, Rutgers University–New Brunswick, New Brunswick, New Jersey, USA
| | - James B. McCauley
- Department of Psychology, St. Mary's College of California, Moraga, California, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
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52
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Kallitsounaki A, Williams DM. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord 2022:10.1007/s10803-022-05517-y. [PMID: 35596023 DOI: 10.1007/s10803-022-05517-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The suggested overlap between autism spectrum disorder (ASD) and gender dysphoria/incongruence (GD/GI) has been much disputed. This review showed a relationship between ASD traits and GD feelings in the general population and a high prevalence of GD/GI in ASD. Our meta-analyses revealed that the pooled estimate of the prevalence of ASD diagnoses in GD/GI people was 11% (p < .001) and the overall effect size of the difference in ASD traits between GD/GI and control people was significant (g = 0.67, p < .001). Heterogeneity was high in both meta-analyses. We demonstrated that the chances that there is not a link between ASD and GD/GI are negligible, yet the size of it needs further investigation.
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Affiliation(s)
- Aimilia Kallitsounaki
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom.
| | - David M Williams
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom
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53
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Espelöer J, Proft J, Falter-Wagner CM, Vogeley K. Alarmingly large unemployment gap despite of above-average education in adults with ASD without intellectual disability in Germany: a cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2022; 273:731-738. [PMID: 35567615 PMCID: PMC10085916 DOI: 10.1007/s00406-022-01424-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/22/2022] [Indexed: 12/28/2022]
Abstract
For individuals with autism spectrum disorder (ASD), both getting access to as well as staying in the labor market are very challenging. However, the detailed educational, vocational, and employment characteristics of persons with ASD without intellectual disabilities are not yet studied. We conducted a retrospective study on a sample of 232 clinically late-diagnosed adults with ASD without intellectual disabilities. Data were compared to the general German population obtained from the public database of the German Federal Employment Agency. Results showed that the majority of persons with ASD graduated from high school and obtained a university entrance qualification (ASD: 50.4%; general population: 32.5%). Also, lower rates of basic secondary education were found in the ASD sample (ASD: 16.5%, general population: 29.6%). Significantly less individuals with ASD completed vocational training (40.1%) in comparison to the German population (56.3%). Despite the above-average level of education, the unemployment rate of the sample substantially exceeds that of the general population by the factor 5 (ASD: 25.2%; general population: 5.2%). Periods of unwanted unemployment of persons with ASD lasted on average 23 months with interpersonal problems being the main reason for contract termination. A higher level of educational qualification does not protect against a higher risk of unemployment for individuals with ASD presumably due to autism-specific interpersonal difficulties. Data emphasize the necessity to develop and spread both specific employment support activities for individuals with ASD as well as adequate awareness raising strategies. Funded by a public grant of the "Landschaftsverband Rheinland (LVR)".
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Affiliation(s)
- Julia Espelöer
- Department of Psychiatry, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Julia Proft
- Department of Psychiatry, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | | | - Kai Vogeley
- Department of Psychiatry, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
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54
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Motor signature of autism spectrum disorder in adults without intellectual impairment. Sci Rep 2022; 12:7670. [PMID: 35538115 PMCID: PMC9090847 DOI: 10.1038/s41598-022-10760-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 12/28/2022] Open
Abstract
Motor signs such as dyspraxia and abnormal gait are characteristic features of autism spectrum disorder (ASD). However, motor behavior in adults with ASD has scarcely been quantitatively characterized. In this pilot study, we aim to quantitatively examine motor signature of adults with ASD without intellectual impairment using marker-less visual-perceptive motion capture. 82 individuals (37 ASD and 45 healthy controls, HC) with an IQ > 85 and aged 18 to 65 years performed nine movement tasks and were filmed by a 3D-infrared camera. Anatomical models were quantified via custom-made software and resulting kinematic parameters were compared between individuals with ASD and HCs. Furthermore, the association between specific motor behaviour and severity of autistic symptoms (Autism Diagnostic Observation Schedule 2, Autism Spectrum Quotient) was explored. Adults with ASD showed a greater mediolateral deviation while walking, greater sway during normal, tandem and single leg stance, a reduced walking speed and cadence, a greater arrhythmicity during jumping jack tasks and an impaired manual dexterity during finger tapping tasks (p < 0.05 and |D|> 0.48) compared to HC. Furthermore, in the ASD group, some of these parameters correlated moderately to severity of ASD symptoms. Adults with ASD seem to display a specific motor signature in this disorder affecting movement timing and aspects of balance. The data appear to reinforce knowledge about motor signs reported in children and adolescents with ASD. Also, quantitative motor assessment via visual-perceptive computing may be a feasible instrument to detect subtle motor signs in ASD and perhaps suitable in the diagnosis of ASD in the future.
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55
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Lai MC. Clinical reflections on the intersections of autism and personality development. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:739-742. [PMID: 35416070 DOI: 10.1177/13623613221088073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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56
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Mantzalas J, Richdale AL, Dissanayake C. A conceptual model of risk and protective factors for autistic burnout. Autism Res 2022; 15:976-987. [PMID: 35416430 DOI: 10.1002/aur.2722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 12/28/2022]
Abstract
Early qualitative research indicates that autistic burnout is commonly experienced by autistic people and is associated with significant, negative consequences for their mental health, wellbeing, and quality of life, including suicidality. Findings to date suggest that factors associated with being autistic and the widespread lack of autism awareness and acceptance within society contribute to the onset and recurrence of autistic burnout. Based on autistic adults' descriptions of their lived experiences, a Conceptual Model of Autistic Burnout (CMAB) is proposed, which describes a series of hypothesized relationships between identified risk and protective factors that may contribute to, or buffer against, autistic burnout. The theoretical framework for the CMAB is based on the Social-Relational model of disability and neurodiversity paradigm, and the Job Demands-Resources model of burnout, and Conservation of Resources theory. The CMAB offers a holistic perspective for understanding individual, social, and environmental factors that can influence autistic burnout via various direct and indirect pathways. Autistic burnout research is in its infancy and the CMAB provides a foundation for future investigations about this condition. LAY SUMMARY: Although many autistic people describe experiencing autistic burnout, there has been little research on this topic. Based on descriptions of autistic peoples' lived experiences, we developed a conceptual model to explore how various risk and protective factors may interact to contribute to, or prevent, autistic burnout.
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Affiliation(s)
- Jane Mantzalas
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
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57
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Saulnier CA, Klaiman C. Assessment of adaptive behavior in autism spectrum disorder. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Celine A. Saulnier
- Neurodevelopmental Assessment & Consulting Services Decatur Georgia USA
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
| | - Cheryl Klaiman
- Department of Pediatrics, Marcus Autism Center Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta Georgia USA
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58
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EEG abnormalities and clinical phenotypes in pre-school children with autism spectrum disorder. Epilepsy Behav 2022; 129:108619. [PMID: 35303620 DOI: 10.1016/j.yebeh.2022.108619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Abnormalities on electroencephalography (EEG) results have been reported in a high percentage of children with Autism Spectrum Disorder (ASD). The purpose of this study was to explore the prevalence of EEG abnormalities in a clinical population of pre-school children with Autism Spectrum Disorder and the differences in terms of the following phenotypic characteristics: adaptive behavior, executive functioning, severity of Autism Spectrum Disorder core symptoms, and comorbidity symptoms. METHODS A cross-sectional analysis of 69 children who attended the Autism Spectrum Disorder early diagnosis program with electroencephalography and clinical diagnosis was performed. A battery of questionnaires was also made to parents to evaluate emotions, behavior, and functional skills for daily living. RESULTS Out of 69 pre-school children with Autism Spectrum Disorder, twenty nine (42%) had abnormalities in electroencephalography results. The group with abnormal epileptiform electroencephalography exhibited more impairment in executive functioning and social-relationship coexisting symptoms. CONCLUSIONS The presence of an abnormal epileptiform electroencephalography in pre-school children with ASD already suggests a worse development in clinical features.
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59
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Balaban G, Bilici M. Anxiety and theory of mind: A moderated mediation model of mindfulness and gender. Psych J 2022; 11:510-519. [DOI: 10.1002/pchj.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Gülşah Balaban
- Department of Psychology Istanbul Sabahattin Zaim University Istanbul Turkey
| | - Mustafa Bilici
- Department of Psychology Marmara University Istanbul Turkey
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60
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Muniandy M, Richdale AL, Arnold SRC, Trollor JN, Lawson LP. Associations between coping strategies and mental health outcomes in autistic adults. Autism Res 2022; 15:929-944. [PMID: 35218321 DOI: 10.1002/aur.2694] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
Abstract
Compared to the general population, mental health difficulties are commonly reported in autistic adults. However, the ways in which coping strategies are associated with mental health and well-being in this population remain unknown. Further, we do not know if, and if so, how these associations might differ to that of non-autistic adults. In this study, we hypothesized that in both our autistic (N = 255) and non-autistic (N = 165) adult samples, disengagement coping strategies (e.g., denial) would relate to poorer mental health and well-being, while engagement coping strategies (e.g., problem solving) would relate to better mental health and well-being. Regression analyses revealed that higher use of disengagement coping strategies was significantly associated with higher levels of anxiety and depression, and lower levels of well-being in both samples. In contrast, increased use of engagement coping strategies was associated with better well-being, but only in the autistic sample. Our results contribute to the characterization of negative and positive mental health outcomes in autistic adults from a coping perspective, with potential to offer novel information regarding coping strategies to consider when addressing support options for mental health difficulties in the autistic adult population.
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Affiliation(s)
- Melanie Muniandy
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Australia
| | - Samuel R C Arnold
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Australia.,Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Australia.,Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, New South Wales, Australia
| | - Lauren P Lawson
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Australia
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61
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Cooke J, Molloy CJ, Cáceres ASJ, Dinneen T, Bourgeron T, Murphy D, Gallagher L, Loth E. The Synaptic Gene Study: Design and Methodology to Identify Neurocognitive Markers in Phelan-McDermid Syndrome and NRXN1 Deletions. Front Neurosci 2022; 16:806990. [PMID: 35250452 PMCID: PMC8894872 DOI: 10.3389/fnins.2022.806990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022] Open
Abstract
Synaptic gene conditions, i.e., “synaptopathies,” involve disruption to genes expressed at the synapse and account for between 0.5 and 2% of autism cases. They provide a unique entry point to understanding the molecular and biological mechanisms underpinning autism-related phenotypes. Phelan-McDermid Syndrome (PMS, also known as 22q13 deletion syndrome) and NRXN1 deletions (NRXN1ds) are two synaptopathies associated with autism and related neurodevelopmental disorders (NDDs). PMS often incorporates disruption to the SHANK3 gene, implicated in excitatory postsynaptic scaffolding, whereas the NRXN1 gene encodes neurexin-1, a presynaptic cell adhesion protein; both are implicated in trans-synaptic signaling in the brain. Around 70% of individuals with PMS and 43–70% of those with NRXN1ds receive a diagnosis of autism, suggesting that alterations in synaptic development may play a crucial role in explaining the aetiology of autism. However, a substantial amount of heterogeneity exists between conditions. Most individuals with PMS have moderate to profound intellectual disability (ID), while those with NRXN1ds have no ID to severe ID. Speech abnormalities are common to both, although appear more severe in PMS. Very little is currently known about the neurocognitive underpinnings of phenotypic presentations in PMS and NRXN1ds. The Synaptic Gene (SynaG) study adopts a gene-first approach and comprehensively assesses these two syndromic forms of autism. The study compliments preclinical efforts within AIMS-2-TRIALS focused on SHANK3 and NRXN1. The aims of the study are to (1) establish the frequency of autism diagnosis and features in individuals with PMS and NRXN1ds, (2) to compare the clinical profile of PMS, NRXN1ds, and individuals with ‘idiopathic’ autism (iASD), (3) to identify mechanistic biomarkers that may account for autistic features and/or heterogeneity in clinical profiles, and (4) investigate the impact of second or multiple genetic hits on heterogeneity in clinical profiles. In the current paper we describe our methodology for phenotyping the sample and our planned comparisons, with information on the necessary adaptations made during the global COVID-19 pandemic. We also describe the demographics of the data collected thus far, including 25 PMS, 36 NRXN1ds, 33 iASD, and 52 NTD participants, and present an interim analysis of autistic features and adaptive functioning.
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Affiliation(s)
- Jennifer Cooke
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Jennifer Cooke,
| | - Ciara J. Molloy
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Antonia San José Cáceres
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Fundación para la Investigación Biomédica del Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
| | - Thomas Dinneen
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Declan Murphy
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Eva Loth
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Eva Loth,
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62
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Maydew H, Atkinson S. The benefits and challenges of conducting research in schools using a single case experimental design. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2022. [DOI: 10.1080/02667363.2022.2033957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Harriet Maydew
- Warwickshire County Council, Educational Psychology Service, Warwick, UK
| | - Sarah Atkinson
- School of Psychology, University of Nottingham, Nottingham, UK
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63
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McCrossin R. Finding the True Number of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. CHILDREN 2022; 9:children9020272. [PMID: 35204992 PMCID: PMC8870038 DOI: 10.3390/children9020272] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Abstract
The proportion of females whose ASD diagnosis is missed is unknown. The ratio of males to females with ASD is generally quoted as 4:1, though it is believed that there are biases preventing females from being diagnosed and that the true ratio is lower. These biases have not been clearly identified or quantified. Starting with a clinical dataset of 1711 children <18 years old, four different methods were employed in an inductive study to identify and quantify the biases and calculate the proportion of females missed. A mathematical model was constructed to compare the findings with current published data. The true male-to-female ratio appears to be 3:4. Eighty percent of females remain undiagnosed at age 18, which has serious consequences for the mental health of young women.
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Affiliation(s)
- Robert McCrossin
- Cooroy Family Practice, Cooroy 4563, Australia;
- Beerwah Family Clinic, Beerwah 4519, Australia
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64
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Calleja S, Kingsley J, Amirul Islam FM, McDonald R. Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers. QUALITATIVE HEALTH RESEARCH 2022; 32:267-278. [PMID: 34906008 DOI: 10.1177/10497323211050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.
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Affiliation(s)
- Shenae Calleja
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan Kingsley
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre of Urban Transitions, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Fakir M Amirul Islam
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
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65
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Missed diagnoses and misdiagnoses of adults with autism spectrum disorder. Eur Arch Psychiatry Clin Neurosci 2022; 272:187-198. [PMID: 32892291 PMCID: PMC8866369 DOI: 10.1007/s00406-020-01189-w] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
Autism spectrum disorder (ASD) is a group of life-long neurodevelopmental disorders affecting 1.5% of the general population. The present study aimed to evaluate the psychiatric history of a group of adults who received the first diagnosis of ASD in two Italian university centers. Diagnoses of ASD were confirmed by a team of psychiatrists with wide expertise in the field, after the administration of standardized tools (i.e., ADOS-2, ADI-R). The sample comprised 161 participants, of which 114 (79.5%) were males. The median age of diagnosis was 23 years (range 18-55), with a median IQ of 100 (range 30-145). The first evaluation by a mental health professional was performed at a median age of 13 years, with a gap of 11 years between the first evaluation and the diagnosis of ASD. 33.5% of participants had never received a psychiatric diagnosis, while the rest of the sample had received one or more diagnoses different from ASD. The most common past diagnoses were intellectual disability, psychoses, personality disorders, and depression. Sex differences were detected in the age of diagnosis and ADOS-2 scores. Our results provide important information for both child and adult psychiatrists. Given the prevalence of autism and the high rates of co-occurrent psychiatric conditions, it is important for clinicians to consider ASD in the differential diagnostic process.
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66
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Varcin KJ, Herniman SE, Lin A, Chen Y, Perry Y, Pugh C, Chisolm K, Whitehouse AJ, Wood SJ. Occurrence of psychosis and bipolar disorder in adults with autism: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 134:104543. [DOI: 10.1016/j.neubiorev.2022.104543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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67
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Wolff N, Stroth S, Kamp-Becker I, Roepke S, Roessner V. Autism Spectrum Disorder and IQ - A Complex Interplay. Front Psychiatry 2022; 13:856084. [PMID: 35509885 PMCID: PMC9058071 DOI: 10.3389/fpsyt.2022.856084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023] Open
Abstract
Autism spectrum disorder (ASD) is characterized as a very heterogeneous child-onset disorder, whose heterogeneity is partly determined by differences in intelligence quotient (IQ). Older epidemiological studies suggested that the IQ-related spectrum tends to be skewed to the left, i.e., a larger proportion of individuals with ASD have below average intelligence, while only few individuals with ASD may have an IQ above average. This picture changed over time with broadening the spectrum view. Within the present perspective article, we discuss discrepancies in IQ profiles between epidemiological and clinical studies and identify potential underlying aspects, for example, the influence of external factors such as sample biases or differences in availability of autism health services. Additionally, we discuss the validity and reciprocal influences of ASD diagnostics and IQ measurement. We put the impact of these factors for diagnostic as well as care and support situations of patients into perspective and want to encourage further research to contribute to the conceptualization of "autism" more comprehensively including the IQ as well as to examine broader (life) circumstances, interacting factors and diagnostic requirements of given diagnoses in childhood as compared to adulthood.
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Affiliation(s)
- Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technische Universität (TU) Dresden, Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technische Universität (TU) Dresden, Dresden, Germany
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Takeuchi J, Sakagami Y. Association between autistic tendency and mental health for studying abroad. Pediatr Int 2022; 64:e14724. [PMID: 33826781 DOI: 10.1111/ped.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To identify the association between autistic tendencies and mental health among university students who study abroad. METHODS We conducted a historical cohort study at a Japanese university, targeting students who went overseas from 2012 to 2014 as part of study abroad program. We administered questionnaires to students before and after they completed the overseas study program. These questionnaires included items about sex, age, academic degrees, department affiliations, past experience of studying abroad, type of overseas program, and schedule of departures and returns. To determine students' mental health problems, we considered cross-cultural maladaptation while studying abroad as the outcome by two reviewers. We also administered the Autism-Spectrum Quotient, Japanese version (AQ), and the General Health Questionnaire 60 Japanese version. We utilized the logistic regression model after adjusting for the General Health Questionnaire and country or region with programs to estimate odds ratios (OR) for considering outcomes. RESULTS Of the 585 who participated in this study excluding two students for cancellations, 352 (60.2%) completed to following-up. The prevalence of mental health problems was 6.0% (21/406) and categorized when studying abroad. The mean AQ score was 19.3 (standard deviation = ±7.12). High AQ (a score of 33 and more) was prevalent among 3.7% (18/486). Students with high AQ had more mental health problems compared to those without high AQ (adjusted ORs 5.87; 95% confidence interval, 1.24-27.9, P = 0.03). CONCLUSIONS We clarified the association between autistic tendencies and mental health for students studying abroad.
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Affiliation(s)
- Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Yu Sakagami
- Kyoto University Health Service, Kyoto, Japan
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Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis. World J Psychiatry 2021; 11:1366-1386. [PMID: 35070783 PMCID: PMC8717043 DOI: 10.5498/wjp.v11.i12.1366] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Differential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD), but clinical assessments often omit screening for personality disorders (PD), which are especially common in individuals with high-functioning ASD where there is less need for support. AIM To summarize the research findings on PD in adults with ASD and without intellectual disability, focusing on comorbidity and differential diagnosis. METHODS PubMed searches were performed using the key words "Asperger's Syndrome", "Autism", "Personality", "Personality disorder" and "comorbidity" in order to identify relevant articles published in English. Grey literature was identified through searching Google Scholar. The literature reviews and reference sections of selected papers were also examined for additional potential studies. The search was restricted to studies published up to April 2020. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria: 16 evaluated personality profiles or PD in ASD (comorbidity), five compared ASD and PD (differential diagnosis) and one performed both tasks. There were significant differences in the methodological approaches, including the ASD diagnostic instruments and personality measures. Cluster A and cluster C PD are the most frequent co-occurring PD, but overlapping features should be considered. Data on differential diagnosis were only found with cluster A and cluster B PD. CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Further studies are needed to explore the complex relationship between ASD and PD.
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Affiliation(s)
- Camilla Rinaldi
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
| | - Margherita Attanasio
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Monica Mazza
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Roberto Keller
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
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Rødgaard EM, Jensen K, Miskowiak KW, Mottron L. Childhood diagnoses in individuals identified as autistics in adulthood. Mol Autism 2021; 12:73. [PMID: 34903278 PMCID: PMC8670291 DOI: 10.1186/s13229-021-00478-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Autism is a developmental condition, where symptoms are expected to occur in childhood, but a significant number of individuals are diagnosed with autism for the first time in adulthood. Here, we examine diagnoses given in childhood among individuals that are diagnosed with autism in adulthood, to investigate whether the late autism diagnosis might be explained by misdiagnosis in childhood or diagnostic overshadowing.
Methods Through the Danish National Patient Registry, we identified individuals diagnosed with autism in adulthood (N = 2199), as well as a control sample with no records of an autism diagnosis (N = 460,798) and calculated how many had received different psychiatric or neurological diagnoses in childhood. Results We found that most childhood diagnoses were overrepresented in those with an adult autism diagnosis, and attention-deficit hyperactivity disorder, affective disorders, anxiety, and stress disorders were the most prevalent childhood conditions in this group. However, 69% of males and 61% of females with adult autism diagnoses were not found to have received any of the investigated diagnoses before 18 years of age, and most childhood diagnoses were given after the age of 12. Limitations Milder to moderate cases of psychiatric conditions that have been solely treated by family physicians or school psychologists may not be fully included in our dataset. The study is based on data from the Danish health care system, and further research is needed to assess whether the findings can be generalized to other countries. Conclusion A majority of those with an adult autism diagnosis had no records of having received any of the investigated diagnoses in childhood. In these cases, the late autism diagnosis is therefore unlikely to be explained by either misdiagnosis or overshadowing. This result is at odds with the prevailing notion that autistic symptoms tend to diminish with age. Therefore, further research is warranted to examine how and if early signs of autism may have manifested among these individuals, and how similar they are to autistic people diagnosed earlier in their development. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00478-y.
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Affiliation(s)
- Eya-Mist Rødgaard
- Department of Psychology, University of Copenhagen, 1353, Copenhagen K, Denmark
| | - Kristian Jensen
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, H3T 1J4, Canada
| | - Kamilla Woznica Miskowiak
- Department of Psychology, University of Copenhagen, 1353, Copenhagen K, Denmark.,Psychiatric Centre Copenhagen, Rigshospitalet, 2100, Copenhagen Ø, Denmark
| | - Laurent Mottron
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, H3T 1J4, Canada. .,Centre de Recherche du CIUSSS-NIM, Hôpital Rivière-des-Prairies, Montreal, QC, H1E 1A4, Canada.
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Khan YS, Khan AW, Tahir ME, Hammoudeh S, Shamlawi MA, Alabdulla M. The impact of COVID-19 pandemic social restrictions on individuals with autism spectrum disorder and their caregivers in the Stateof Qatar: A cross-sectional study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104090. [PMID: 34624722 PMCID: PMC8481093 DOI: 10.1016/j.ridd.2021.104090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Previous research has established an association between changes to the daily routine of individuals with Autism Spectrum Disorder (ASD) and increase in maladaptive behaviours. The relationship between maladaptive behaviours in autistic individuals and increase in care burden among their caregivers is also well established. However, no study has yet examined these associations in the context of the COVID-19 pandemic. The main aim of this study was to explore the impact of COVID-19 restrictions on autistic individuals and their caregivers. METHODS A questionnaire-based cross-sectional study conducted with the caregivers of 58 autistic individuals across the mental health services at Hamad Medical Corporation, Doha, Qatar. The extent of care burden was measured using the Care Burden Interview, whereas changes in behaviour in autistic individuals was assessed using the Revised Overt Aggression Scale. RESULTS A total of 58 caregivers participated in the study. Out of these, 24 (41 %) reported a clinically significant increase in their care burden. Among caregivers reporting an increase in care burden, two-third were caring for individuals whose behaviour either remained unchanged or improved during social restrictions. Nine autistic people (15.5 %) were reported to have no aggression prior to the implementation of COVID-19 social restrictions compared to 13 (22.4%) individuals during COVID-19 social restrictions. Minimal, mild and moderate aggression were reported in 27 (46.6 %), 21 (36.2 %), and 1 (1.7 %) patients respectively, before COVID-19 social restrictions compared to 29 (50 %), 15 (25.9), and 1 (1.7 %) during COVID-19 restrictions. Severe aggression was not reported in any patient either before or during COVID-19 social restrictions. CONCLUSION This study showed reduced levels of aggression in autistic individuals but an increase in care burden among their caregivers during the COVID-19 social restrictions highlighting the need of supporting patients and caregivers alike.
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Lipinski S, Boegl K, Blanke ES, Suenkel U, Dziobek I. A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1509-1521. [PMID: 34825580 PMCID: PMC9344568 DOI: 10.1177/13623613211057973] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most adults on the autism spectrum have co-occurring mental health
conditions, creating a high demand for mental health services –
including psychotherapy – in autistic adults. However, autistic adults
have difficulties accessing mental health services. The most-reported
barriers to accessing treatment are therapists’ lack of knowledge and
expertise surrounding autism, as well as unwillingness to treat
autistic individuals. This study was conducted by a participatory
autism research group and examined 498 adult-patient psychotherapists
on knowledge about autism and self-perceived competency to diagnose
and treat autistic patients without intellectual disability compared
to patients with other diagnoses. Psychotherapists rated their
education about autism in formal training, and competency in the
diagnosis and treatment of patients with autism, lowest compared to
patients with all other diagnoses surveyed in the study, including
those with comparable prevalence rates. Many therapists had
misconceptions and outdated beliefs about autism. Few had completed
additional training on autism, but the majority were interested in
receiving it. Greater knowledge about autism was positively linked to
openness to accept autistic patients. The results point to an alarming
gap in knowledge necessary for adequate mental health care for
individuals with autism.
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Affiliation(s)
| | | | - Elisabeth S Blanke
- Humboldt-Universität zu Berlin, Germany.,Friedrich-Schiller-Universität, Germany
| | | | - Isabel Dziobek
- Humboldt-Universität zu Berlin, Germany.,Charité - Universitätsmedizin Berlin, Germany.,Freie Universität Berlin, Germany.,Berlin Institute of Health, Germany
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May T, Pilkington PD, Younan R, Williams K. Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Res 2021; 14:2688-2710. [PMID: 34608760 DOI: 10.1002/aur.2619] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022]
Abstract
Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or case-controlled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. LAY SUMMARY: Autism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Pamela D Pilkington
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Rita Younan
- Schema Therapy Institute of Australia, Carlton, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Murdoch Childrens Research Centre, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Dugdale AS, Thompson AR, Leedham A, Beail N, Freeth M. Intense connection and love: The experiences of autistic mothers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1973-1984. [PMID: 33840262 PMCID: PMC8419292 DOI: 10.1177/13623613211005987] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
LAY ABSTRACT For many women, adulthood involves becoming a mother. Knowledge of how motherhood is experienced by autistic women is currently poor. Poor knowledge has a range of negative consequences and can lead to inappropriate support. In this study, nine autistic women were interviewed about their experiences of motherhood. Seven of the nine mothers had an officially diagnosed autistic child, the final two mothers also suspected at least one of their children to be autistic. Systematic in-depth analysis of interview transcripts identified a range of common themes. Participants largely experienced motherhood as joyful, rewarding, and enjoyable, though managing children's needs had a profound personal impact. Participants reflected on the need for self-care and self-acceptance, resulting in personal growth and adaptation. Participants also spoke of strong bonds, feelings of intense connection, and a range of shared experiences with their children. It was also clear that autistic motherhood is associated with a series of challenges unlikely to be experienced by non-autistic mothers, including the necessity of negotiating misunderstandings from others. The findings demonstrate that, generally, professionals need to be better educated on how autism presents in adulthood, including the fact that autistic women often engage in behaviour to mask their true self. Professionals need to know that there is potential for mismatching between emotional experience and facial expression, that autistic women have sensory needs (especially in pregnancy). Professionals frequently struggle to effectively take the needs and perspectives of autistic mothers into account, resulting in profoundly negative consequences for the mother.
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Affiliation(s)
| | - Andrew R Thompson
- University of Sheffield, UK
- Cardiff and Vale University Health Board & Cardiff University, UK
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Deficits in Working Memory and Theory of Mind May Underlie Difficulties in Social Perception of Children with ADHD. Neurol Res Int 2021; 2021:3793750. [PMID: 34497727 PMCID: PMC8421162 DOI: 10.1155/2021/3793750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/04/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
Children with attention deficit hyperactivity disorder (ADHD) are prone to peer rejection and disliking due to difficulties in social perception and interaction. To address social perception impairments in ADHD, we examined children with ADHD in a noisy biological motion (BM) direction discrimination paradigm in association with sociocognitive factors including emotion regulation, theory of mind (TOM), and working memory compared to healthy controls. Our results showed that children with ADHD were poorer in discriminating BM direction in noisy environments (F (1, 36) = 4.655, p=0.038). Moreover, a significant correlation was found between working memory and TOM with BM discrimination in an ADHD group (r = 0.442, p=0.01, and r = 0.403, p=0.05, respectively). Our findings could suggest that social perception in noisy scenarios may be affected by memory and social cognitive abilities of children with ADHD.
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Cai RY, Brown L. Cultivating Self-Compassion to Improve Mental Health in Autistic Adults. AUTISM IN ADULTHOOD 2021; 3:230-237. [PMID: 36605368 PMCID: PMC8992903 DOI: 10.1089/aut.2020.0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Many autistic adults experience poor mental health. Research has consistently shown that cultivating self-compassion is a promising approach to strengthening resilience in nonautistic adults. Self-compassion is a trainable skill that is associated with several mental health benefits, such as higher levels of happiness and well-being as well as lower symptoms of depression and anxiety. However, no studies to date have explored self-compassion in autistic individuals. We suggest that self-compassion may be a relevant target in mental health interventions for autistic adults without severe or profound intellectual disability. Self-compassion may improve mental health in autistic adults through directly modifying emotions (as an emotion regulation strategy) or its interactions with emotion regulation processes. Existing approaches to cultivating self-compassion include identifying and practicing self-compassionate behaviors, using self-compassionate thought records, and practicing self-compassion meditations. Before self-compassion approaches are implemented by autistic adults, it will be necessary to evaluate their role and effectiveness in mental health through carefully designed studies. We suggest that researchers should first study the relationship between self-compassion and mental health outcomes in autistic adults. Once researchers have established the connection, we can then begin to study self-compassion-based interventions for autistic adults. Relevant clinical considerations include identifying the autistic groups that self-compassion practices are suitable for, determining how autistic adults with and without mental health conditions can effectively practice self-compassion (on their own and with the support of clinicians), and evaluating existing self-compassion tools or designing new tools. It is also relevant for future research to identify the enablers and barriers to using self-compassion in autistic adults. Lay summary What is self-compassion?: Self-compassion is when we: are friendly toward ourselves (kindness)are aware of our feelings and thoughts (mindful awareness)realize that everyone feels pain and makes mistakes (common humanity)What is the purpose of this article?: We think that practicing self-compassion is important for autistic adults. No research has studied self-compassion in autistic individuals. We provide examples of how to improve self-compassion. We make recommendations for future research on self-compassion for autistic adults.What perspectives do the authors bring to this subject?: We bring together different and unique perspectives in this article. One author is a researcher whose research has focused on emotion regulation and mental health in autistic youth and adults. The other author is a self-compassion researcher who is also a private practice clinical psychologist. We have practiced self-compassion and personally experienced the benefits of developing our self-compassion skills. We think that cultivating self-compassion has helped to improve our mental health and enriched our lives.Why is self-compassion important?: Self-compassion is associated with a lot of positive aspects of life in nonautistic individuals. These positive aspects include greater happiness and well-being, and lower levels of depression and anxiety symptoms.How is self-compassion relevant to autistic adults?: We know that as a group, autistic adults have poorer mental health when compared with nonautistic adults. That is, autistic adults experience higher rates of anxiety and depression. Research shows that practicing self-compassion in nonautistic people can improve their mental health. We think that cultivating self-compassion can also be helpful to autistic adults.What do the authors recommend?: We suggest that cultivating self-compassion may improve the mental health of autistic adults. There are several ways to improve self-compassion. Self-compassion can be improved by identifying and practicing self-compassionate behaviors. For example, we can take a walk outside. Another way to improve self-compassion is to record our thoughts. This can be performed by keeping a log of self-critical thoughts. We can also practice self-compassion by meditating. It is too early to tell how self-compassion should be practiced by autistic adults. Research is needed to observe if self-compassion is helpful to autistic adults. We made a series of recommendations for researchers and clinicians. Researchers should first check if there is a relationship between self-compassion and mental health in autistic adults. If more self-compassion is associated with better mental health, then researchers and clinicians can try and find out how we can improve autistic people's self-compassion.How will these recommendations help autistic adults now or in the future?: We hope that our recommendations will start a conversation on the relevance of self-compassion for autistic adults and lead to the development of self-compassion-related research programs that involve autistic adults. The ultimate goal is to improve the mental health and psychological well-being of autistic adults in the future.
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Affiliation(s)
- Ru Ying Cai
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Flemington, Australia.,Macquarie School of Education, Faculty of Arts, Macquarie University, Sydney, Australia.,Address correspondence to: Ru Ying Cai, PhD, Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 173 Wellington Street, Flemington 3031, Australia.
| | - Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia.,North Eastern Rehabilitation Centre, Healthscope Hospitals, Ivanhoe, Australia.,School of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Jose C, George-Zwicker P, Bouma A, Tardif L, Pugsley D, Bélanger M, Robichaud M, Gaudet J. The Associations Between Clinical, Social, Financial Factors and Unmet Needs of Autistic Adults: Results from an Observational Study. AUTISM IN ADULTHOOD 2021; 3:266-274. [PMID: 36605370 PMCID: PMC8992900 DOI: 10.1089/aut.2020.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Autism is a developmental disability that affects how individuals experience the world. Each Autistic individual experiences Autism in their own way, meaning that the level and type of assistance in their everyday lives vary widely. A shortage of programs and services tailored to Autistic adults exists worldwide, and the current gap between needs and services is likely to worsen as the growing number of Autistic children being diagnosed reach adulthood. This research sought to determine priorities in terms of health and social service needs of Autistic adults and to examine factors influencing whether or not these services were being received. Methods Through a multistakeholder approach, researchers and Autistic adults codeveloped the Maritime Provinces Needs Assessment Survey and collected data from August 2017 to February 2018. The research team engaged Autistic adult partners, including one that was project colead, as full partners. We recruited survey respondents from three Maritime Provinces using mainly social media and local Autism networks. We used Poisson regression analyses to identify factors most strongly associated with the number of unmet needs reported by Autistic adults. Results In total, 260 respondents completed the needs assessment survey: 77 self-reporting Autistic adults (aged 19-55 years), 87 Autistic adults (aged 18-63 years) whose information was provided by a proxy respondent, and 96 professionals working in the field of Autism. Autistic adults reported a mean of 2.1 ± 1.5 (self-reported) and 2.8 ± 2.1 (proxy-reported) services wanted but not received. The number of mental health and neurodevelopmental conditions, unemployment, and perception that government support is insufficient were positively related to unmet needs. Conclusions Overall, the results of this study highlight considerable gaps among the support needs of Autistic adults. The identification of factors associated with a higher number of unmet needs helps identify potential subgroups requiring more attention. Lay summary Why was this study done?: There is currently a shortage of programs and services for Autistic adults. Little is known about which services are most important to Autistic adults and which factors are associated with not receiving them.What was the purpose of this study?: Our goals were (1) to determine the service need priorities of Autistic adults and (2) to examine factors associated with unmet needs.What did the researchers do?: The researchers invited health professionals, service providers, policy makers, Autism advocates, as well as Autistic adults and caregivers of Autistic adults to participate as part of the project team. In the early phases of the project, we named an Autistic adult colead of the project. In doing so, we acknowledged that conducting relevant research on the Autistic adult community implies not only hearing their voices and concerns, but also providing an opportunity for equal say on the research itself.We adapted previously used surveys to align them with our objectives of focusing only on Autistic adults. We launched the survey online and promoted it using various media and community channels, many of them direct suggestions from Autistic adult team members. We made paper copies available and provided a phone number for those who needed support filling out the survey.What were the results of the study?: More than 25% of Autistic adults identified 12 different services as priority needs.Autistic adults who (1) reported more mental health and neurodevelopmental conditions, (2) perceived their mental health as poor, or (3) felt that government support was insufficient were at greater risk of having unmet needs.What do these findings add to what was already known?: Similar to previous studies, we found that the service needs of Autistic adults are varied, and that many are not receiving the services they consider a priority. Our study also went one step further by identifying factors that are associated with a higher number of unmet needs.What are potential weaknesses in the study?: Our sample does not necessarily reflect the Autistic adult community as a whole, since we were unable to guarantee that hard-to-reach segments had access to our survey. In addition, we are unable to know how our results may change over time, as our survey was filled out on one occasion only. Finally, we did not measure Autistic traits and therefore are unable to estimate how different types of traits are associated with certain needs.How will these findings help autistic adults now or in the future?: Our results may help bring attention to subgroups of Autistic adults who need more help receiving the services they require.
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Affiliation(s)
- Caroline Jose
- Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada.,Research Laboratory on Chronic Disease Prevention, Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada.,Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patricia George-Zwicker
- Patient Partner, CONNECT Project, Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada.,Autistics Aloud, Halifax, Nova Scotia, Canada
| | - Aaron Bouma
- Patient Partner, CONNECT Project, Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada
| | - Louise Tardif
- Patient Partner, CONNECT Project, Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada
| | - Darlene Pugsley
- Patient Partner, CONNECT Project, Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada
| | - Mathieu Bélanger
- Research Laboratory on Chronic Disease Prevention, Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada.,Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Vitalité Health Network, Centre Hospitalier Universitaire Dr. Georges-L.-Dumont/Dr. Georges-L.-Dumont University Hospital Centre, Moncton, New Brunswick, Canada
| | - Marc Robichaud
- Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada.,Research Laboratory on Chronic Disease Prevention, Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada
| | - Jeffrey Gaudet
- Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Moncton, New Brunswick, Canada.,Research Laboratory on Chronic Disease Prevention, Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada.,Address correspondence to: Jeffrey Gaudet, MSc, Maritime Strategy for Patient Oriented Research Support Unit, Université de Moncton, Campus de Moncton, 18 Antonine-Maillet Ave, Moncton, NB E1A 3E9, Canada.
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Kamp-Becker I, Tauscher J, Wolff N, Küpper C, Poustka L, Roepke S, Roessner V, Heider D, Stroth S. Is the Combination of ADOS and ADI-R Necessary to Classify ASD? Rethinking the "Gold Standard" in Diagnosing ASD. Front Psychiatry 2021; 12:727308. [PMID: 34504449 PMCID: PMC8421762 DOI: 10.3389/fpsyt.2021.727308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022] Open
Abstract
Diagnosing autism spectrum disorder (ASD) requires extensive clinical expertise and training as well as a focus on differential diagnoses. The diagnostic process is particularly complex given symptom overlap with other mental disorders and high rates of co-occurring physical and mental health concerns. The aim of this study was to conduct a data-driven selection of the most relevant diagnostic information collected from a behavior observation and an anamnestic interview in two clinical samples of children/younger adolescents and adolescents/adults with suspected ASD. Via random forests, the present study discovered patterns of symptoms in the diagnostic data of 2310 participants (46% ASD, 54% non-ASD, age range 4-72 years) using data from the combined Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) and ADOS data alone. Classifiers built on reduced subsets of diagnostic features yield satisfactory sensitivity and specificity values. For adolescents/adults specificity values were lower compared to those for children/younger adolescents. The models including ADOS and ADI-R data were mainly built on ADOS items and in the adolescent/adult sample the classifier including only ADOS items performed even better than the classifier including information from both instruments. Results suggest that reduced subsets of ADOS and ADI-R items may suffice to effectively differentiate ASD from other mental disorders. The imbalance of ADOS and ADI-R items included in the models leads to the assumption that, particularly in adolescents and adults, the ADI-R may play a lesser role than current behavior observations.
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Affiliation(s)
- Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Johannes Tauscher
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Charlotte Küpper
- Department of Psychiatry, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
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79
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Vuijk R, Deen M, Arntz A, Geurts HM. First Psychometric Properties of the Dutch Interview for Diagnostic Assessment of Autism Spectrum Disorder in Adult Males Without Intellectual Disability. J Autism Dev Disord 2021; 52:3523-3535. [PMID: 34409554 DOI: 10.1007/s10803-021-05225-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
For autism spectrum disorder (ASD) in adults there are several diagnostic instruments available with a need for consideration of the psychometric properties. This study aimed to conduct a first psychometric evaluation of a new diagnostic ASD instrument, the NIDA (Dutch Interview for Diagnostic assessment of ASD in adults) in 90 adult males without intellectual disability (age 18-65 years) in the Netherlands: 30 with ASD, 30 with a Personality Disorder and 30 nonpatient controls. The interrater agreement ranged from 0.79 to 1.00, the convergent validity including sensitivity and specificity ranged from 0.76 to 1.00, and we observed an adequate concurrent criterion-related validity. These promising findings can serve as foundation for future psychometric NIDA studies in a more diverse population. TRIAL REGISTRATION: The Netherlands National Trial Register NTR6391. Registered 04 May 2017.
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands.
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 32, 2552 DH, The Hague, The Netherlands.,Institute of Psychology, Methodology and Statistics Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Arnoud Arntz
- University of Amsterdam, Postbus 15933, 1001 NK, Amsterdam, The Netherlands
| | - Hilde M Geurts
- University of Amsterdam, Postbus 15933, 1001 NK, Amsterdam, The Netherlands.,Dr. Leo Kanner Huis, Youz, Parnassia Psychiatric Institute, Derkinderenstraat 10-18, 1062 DB, Amsterdam, The Netherlands
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80
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Early Reflections on the Therapeutic Effects of Mindfulness-Based Therapies in Adults with Autism and Suggestions for Future Research. ACTA ACUST UNITED AC 2021; 6. [PMID: 34395921 PMCID: PMC8362926 DOI: 10.20900/jpbs20210013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Emerging research suggests mindfulness-based therapies positively impact adults with autism spectrum disorder (ASD). However, questions concerning intervention active ingredients, the breadth and duration of impact, and psychological and neural mechanisms of change remain. Here we discuss what is known about mindfulness-based therapies in adults with ASD and offer suggestions for future research.
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81
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Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02061-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractThe guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.
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82
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Are Mental Health, Family and Childhood Adversity, Substance Use and Conduct Problems Risk Factors for Offending in Autism? J Autism Dev Disord 2021; 51:2057-2067. [PMID: 32915355 PMCID: PMC8124051 DOI: 10.1007/s10803-020-04622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mental health difficulties, family and childhood adversity factors, substance use and conduct problems have all been linked to offending behaviour in the general population. However, no large-scale study with comparison groups has investigated these risk factors in relation to autistic offenders. The current research included 40 autistic offenders, 40 autistic non-offenders, 40 typically developed (TD) offenders and 39 TD non-offenders. Conduct problems risk factors differentiated autistic offenders from both non-offender groups (autistic and TD) and mental health risk factors differentiated autistic offenders from both TD groups (offenders and non-offenders). Further research is required to understand more about the role of both conduct problems risk factors in autistic offenders (e.g., age at onset, frequency of behaviours) and the mental health needs of autistic offenders.
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83
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Scheeren AM, Buil JM, Howlin P, Bartels M, Begeer S. Objective and subjective psychosocial outcomes in adults with autism spectrum disorder: A 6-year longitudinal study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:243-255. [PMID: 34169776 PMCID: PMC8750151 DOI: 10.1177/13623613211027673] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research has shown lower rates of employment and independent living in
adults with autism. Many of these findings are based on
cross-sectional studies, predominantly involving male participants. In
a 6-year longitudinal study, we examined determinants of psychosocial
outcomes in 917 adults with autism spectrum disorder (425 men, 492
women, mean age 43.5 years). Most were diagnosed in adulthood and had
(above) average intellectual abilities. Via a yearly online survey,
participants’ objective psychosocial functioning (based on employment,
independent living and friendship) and subjective well-being were
assessed. Averaged across the five waves of the study, 86% of the
sample showed a fair to very good level of objective psychosocial
functioning. Objective psychosocial functioning and subjective
well-being were positively correlated, and both improved over time.
Lower intellectual ability, more autism traits, co-occurring
psychiatric conditions and younger age predicted poorer objective
outcomes. More autism traits and co-occurring psychiatric conditions
predicted lower subjective well-being. There were no gender
differences in initial levels of, or changes in, objective and
subjective outcomes over time. This study has identified important
risk/protective factors for psychosocial outcomes across early and
middle adulthood. In general, the findings offer a more positive
outlook for adults with autism and average to high intellectual
abilities.
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84
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Block G, Jannati A, Maynard TR, Pascual-Leone A, O’Connor MG. Personality in Autism Spectrum Disorder: Associations With Face Memory Deficit and Theory of Mind. Cogn Behav Neurol 2021; 34:117-128. [PMID: 34074866 PMCID: PMC8186733 DOI: 10.1097/wnn.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the personality profiles of adults with autism spectrum disorder (ASD) using a standard personality assessment and to investigate the association between personality, ASD-related face memory deficit (FMD), and theory of mind (ToM). In a broader context, to examine whether there are distinct clinical phenotypes in the ASD population that have implications for personality development and treatment. METHOD Fifty-five adults with ASD and 22 neurotypical (NT) adults underwent a battery of neuropsychological tests, including measures of personality, face memory, and ToM. We compared ASD and NT groups in terms of their Personality Assessment Inventory (PAI) profiles. Additional analyses focused on the association between specific PAI scales and FMD. Performance on the Eyes Test was compared across groups and was examined in relation to FMD. RESULTS Adults with ASD demonstrated significant elevations on several PAI scales compared with NT adults. The presence of FMD was associated with differing PAI profiles among the ASD adults. The ASD adults with FMD scored significantly higher on scales that are sensitive to positive impression management and treatment rejection and significantly lower on scales that are sensitive to borderline personality, anxiety, depression, schizophrenia, and stress. There was a significant association between performance on the Eyes Test and FMD in the ASD group. CONCLUSION Adults with ASD have a unique personality profile. Further, ASD adults with FMD have reduced insight into their difficulties with emotional processing and may not be as sensitive as ASD adults without FMD to the emotions of others.
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Affiliation(s)
- Gabrielle Block
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Taylor R. Maynard
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Margaret G. O’Connor
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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85
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Sampson KN, Upthegrove R, Abu-Akel A, Haque S, Wood SJ, Reniers R. Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality. Psychol Med 2021; 51:1364-1372. [PMID: 32081111 DOI: 10.1017/s0033291720000124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality. METHODS Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed. RESULTS A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits. CONCLUSIONS This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.
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Affiliation(s)
- Katie N Sampson
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Sayeed Haque
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Birmingham, UK
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Renate Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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86
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Cornwall PL, Simpson S, Gibbs C, Morfee V. Evaluation of radically open dialectical behaviour therapy in an adult community mental health team: effectiveness in people with autism spectrum disorders. BJPsych Bull 2021; 45:146-153. [PMID: 33261708 PMCID: PMC9059310 DOI: 10.1192/bjb.2020.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS AND METHOD Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment designed to address disorders associated with overcontrol, including autism spectrum disorders (ASD). To date, no studies have reported on the effectiveness of RO DBT for people with ASD. Forty-eight patients were referred to a RO DBT programme, of whom 23 had a diagnosis of ASD. Outcome was measured using the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE) and the Questionnaire about the Process of Recovery. RESULTS The intervention was effective, with a medium effect size of 0.53 for improvement in CORE global distress. End-point CORE global distress score was predicted from initial severity and a diagnosis of ASD. Participants with a diagnosis of ASD who completed the therapy had significantly better outcomes than completing participants without an ASD diagnosis. CLINICAL IMPLICATIONS These findings provide preliminary support for RO DBT as an effective intervention for ASD in routine settings.
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Affiliation(s)
- Peter L Cornwall
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Susan Simpson
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Claire Gibbs
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Valerie Morfee
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
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87
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Stark E, Ali D, Ayre A, Schneider N, Parveen S, Marais K, Holmes N, Pender R. Coproduction with Autistic Adults: Reflections from the Authentistic Research Collective. AUTISM IN ADULTHOOD 2021; 3:195-203. [PMID: 36601467 PMCID: PMC8992895 DOI: 10.1089/aut.2020.0050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article explores coproduction in relation to autistic people. We reflect on the coproduction process with autistic adults from the Authentistic Research Collective at University College London. We aimed to support the autistic population's mental health needs by coproducing a document on adapting psychological therapy, and by developing a set of reflective guidelines to guide and encourage future coproduction initiatives between autistic and nonautistic team members. We reflect upon six elements that are of potential importance for future coproduction projects with autistic adults: (1) the meaning of coproduction; (2) ground rules and a traffic light system; (3) environmental adaptations; (4) digital communication tools; (5) encouraging authenticity; and (6) supporting autistic strengths. We conclude by discussing future research avenues into optimizing coproduction with autistic people, and how such research may influence both practice and policy. Lay summary Why is coproduction important?: Coproduction means creating things jointly with others. Ideally, autistic people should be involved in research that is about them so that their thoughts and opinions are included. Coproduction allows this to happen.What is the purpose of this article?: There is little advice for how autistic and nonautistic people can work together to coproduce useful research. This article hopes to encourage discussion by sharing our reflections on how we used coproduction in our project.What did we do?: Our group was made up of autistic and nonautistic people. One of our goals was to gain experience in using coproduction. We created this article containing our reflections-what we found worked well, and what we felt could be done differently in the future.What did we learn?: We learnt the importance of five key areas: (1) group rules, and a "traffic light" system to help group members show how they like to communicate; (2) adapting the environment to suit people's needs; (3) inclusion of digital communication tools; (4) encouraging group members to feel they are authentic (be fully themselves); and (5) supporting autistic strengths. We hope that the discussion of these themes will be helpful for future coproduction projects.
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Affiliation(s)
- Eloise Stark
- Authentistic Research Collective, University College London, London, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom.,Address correspondence to: Eloise Stark, MA (Oxon), Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Dorota Ali
- Authentistic Research Collective, University College London, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Annalise Ayre
- Authentistic Research Collective, University College London, London, United Kingdom
| | - Naomi Schneider
- Authentistic Research Collective, University College London, London, United Kingdom
| | - Sophia Parveen
- Authentistic Research Collective, University College London, London, United Kingdom
| | - Keith Marais
- Authentistic Research Collective, University College London, London, United Kingdom
| | - Nick Holmes
- Authentistic Research Collective, University College London, London, United Kingdom
| | - Richard Pender
- Authentistic Research Collective, University College London, London, United Kingdom
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88
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Micai M, Ciaramella A, Salvitti T, Fulceri F, Fatta LM, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Scattoni ML, Schendel D. Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project. Front Psychiatry 2021; 12:614102. [PMID: 34122158 PMCID: PMC8193054 DOI: 10.3389/fpsyt.2021.614102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults-especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services.
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Affiliation(s)
- Martina Micai
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Antonio Ciaramella
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Tommaso Salvitti
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Francesca Fulceri
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Laura Maria Fatta
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Andrew Martin Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | | | | | - Irma Moilanen
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Faculty of Social Sciences, University of Tampere, Logopedics, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Stockholm, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Célia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Magdalena Budişteanu
- ‘Victor Babeş’ National Institute for Research and Development in Pathology and Biomedical Sciences, Timisoara, Romania
| | - Ian Dale
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Carol Povey
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Noelia Flores
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva y de la Educación, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Patricia García Primo
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Tony Charman
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Maria Luisa Scattoni
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Economics and Business, National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
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Mayhew E, Stuttard L, Beresford B. An Assessment of the Psychometric Properties of the GHQ-12 in an English Population of Autistic Adults Without Learning Difficulties. J Autism Dev Disord 2021; 51:1093-1106. [PMID: 32653976 PMCID: PMC7985123 DOI: 10.1007/s10803-020-04604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Valid and reliable tools to measure mental health are a key requirement to developing a robust evidence base on mental health difficulties and autism. There are several reasons why mental health measures developed for the neurotypical population may not be valid and reliable when used with autistic adults. Using data collected from a national evaluation of community-based, specialist autism provision in England, this study assessed the psychometric properties of the General Health Questionnaire (GHQ-12) in a population of autistic adults without learning difficulties. We examined the measure’s acceptability, reliability and internal construct validity. The GHQ-12 was found to have good psychometric properties in this population. This provides first evidence that this measure can be used with autistic adults without LD.
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Affiliation(s)
- Emese Mayhew
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK.
| | - Lucy Stuttard
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK
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90
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A Systematic Review of Healthcare Professionals’ Knowledge, Self-Efficacy and Attitudes Towards Working with Autistic People. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00263-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractHealthcare professionals play a vital role in identifying and supporting autistic people. This study systematically reviewed empirical research examining healthcare professionals’ knowledge, self-efficacy and attitudes towards working with autistic people. Thirty-five studies were included. The included studies sampled a range of countries and professional backgrounds. A modified quality assessment tool found the quality of the included studies was moderately good. Narrative synthesis indicated that healthcare professionals report only moderate levels of autism knowledge and self-efficacy, and often lack training. Variation within and between countries and professional background was not explained by demographic factors. The reviewed evidence suggests health professionals’ limited knowledge and self-efficacy in working with autistic people is a challenge to the provision of healthcare for autistic individuals.
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91
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Bechi M, Abu-Akel A, Agostoni G, Bosia M, Cocchi F, Spangaro M, Cavallaro R. Functional benefits of co-occurring autistic symptoms in schizophrenia is delimited by symptom severity. J Psychiatr Res 2021; 137:48-54. [PMID: 33652326 DOI: 10.1016/j.jpsychires.2021.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impairments in daily functioning characterize both autism spectrum disorder and schizophrenia. Research has shown that a subsample of schizophrenia patients presents autistic symptoms, leading to the hypothesis that their co-occurrence would be associated with a 'double dose' of deficit. A growing body of research examined this hypothesis by looking at the joint effect of autistic and positive psychotic symptoms, and yielded contrasting results, ranging from benefits to adverse effects. We hypothesized that the interactive effect of autistic and positive symptoms on functioning in schizophrenia might depend on the patients' symptom severity. METHOD In 170 schizophrenia patients, a two-step cluster analysis identified two groups of patients with different levels of autistic and positive symptom severity. Using general linear models, we examined the interactions of groups, autistic and positive symptoms on functioning. RESULTS Autistic and positive symptoms were interactively associated with better functioning, but only in the symptomatically less severe patients. In contrast, autistic and positive symptoms were independently associated with worse functioning in the symptomatically more severe patients. These associations were observed above and beyond the effects of I.Q. and illness duration. CONCLUSIONS The findings highlight the complex role played by co-occurring autistic symptoms in schizophrenia, whose beneficial effects on functioning appear to depend on patients' psychopathological severity. Our findings may help to reconcile the seemingly contrasting results from previous studies, and to understand the heterogeneity of behavior and functional outcomes in schizophrenia. This study underscores the potential utility of routinely assessing autism in schizophrenia, in order to better formulate individualized rehabilitative programs.
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Affiliation(s)
- Margherita Bechi
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Giulia Agostoni
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marta Bosia
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Cocchi
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Spangaro
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Cavallaro
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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92
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Leader G, Barrett A, Ferrari C, Casburn M, Maher L, Naughton K, Arndt S, Mannion A. Quality of life, gastrointestinal symptoms, sleep problems, social support, and social functioning in adults with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103915. [PMID: 33676088 DOI: 10.1016/j.ridd.2021.103915] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between sleep problems, gastrointestinal symptoms, social functioning, autism traits, and social support on quality of life (QoL) in 107 adults with autism spectrum disorder (ASD). METHOD Questionnaires included the Autism Spectrum Quotient-10 (Adult), Multidimensional Scale of Perceived Social Support, Social Functioning Questionnaire, Pittsburgh Sleep Quality Index, Gastrointestinal Symptom Inventory, and World Health Organization Quality of Life-BREF. RESULTS GI symptoms were a common comorbidity with 86 % of participants presenting with them. Sleep problems were also frequent issues with 89 % of participants being classified as poor sleepers. Greater sleep problems were correlated with poorer QoL in the physical health and environment domains. Specifically, the sleep problem of daytime dysfunction was correlated with poorer QoL in physical health. Daytime dysfunction and sleep duration were correlated with poorer QoL in the environment domain. Better social support was correlated with greater QoL in the psychological, social and environment domains. Poorer social functioning was correlated with poorer QoL in each of the four domains. CONCLUSION This research indicated that GI symptoms and sleep problems are common comorbid conditions in the adult ASD population. This paper expanded upon the existing literature by highlighting unexplored factors influencing QoL in adults with ASD.
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Affiliation(s)
- Geraldine Leader
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland.
| | - Amy Barrett
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Chiara Ferrari
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Mia Casburn
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Leanne Maher
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Katie Naughton
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Sophia Arndt
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Arlene Mannion
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
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93
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Bürki L, Höfer J, Kamp-Becker I, Poustka L, Roessner V, Stroth S, Wolff N, Hoffmann F, Bachmann C. Special educational support in children and adolescents with Autism Spectrum Disorder in Germany: Results from a parent survey. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103931. [PMID: 33690110 DOI: 10.1016/j.ridd.2021.103931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Children and adolescents with Autism Spectrum Disorder (ASD) often receive special educational support (SES). This study aimed to evaluate SES prevalence in children and adolescents with ASD in Germany. METHODS A mail survey was distributed to the caregivers of 637 children and adolescents recruited at three German ASD outpatient clinics. RESULTS Among the 211 respondents (response: 33.1 %), 82.5 % were provided with a special educational needs statement, and 63.9 % received special education, most of them attending a public special school (57.9 %). The most frequently indicated additional support was a classroom assistant (69.0 %), followed by smaller learning groups (31.7 %). Special education was less frequently provided to individuals with Asperger syndrome than to those with childhood or atypical autism (36.0 %, 76.1 %, and 63.4 %, respectively). Using logistic regression analysis, receiving special education was significantly associated with lower IQ (<85) (Odds Ratio (OR): 8.72; 95 % confidence interval (CI): 3.41-22.32) and younger age (≤11 years, OR: 2.87; 95 % CI: 1.11-7.38), but not with ASD symptom severity. CONCLUSIONS The majority of children and adolescents with ASD received SES, indicating a satisfactory supply of such services in Germany. The finding that lower IQ but not ASD symptom severity predicted access to SES raises questions about the specificity of the used selection criteria.
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Affiliation(s)
- Lara Bürki
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany.
| | - Juliana Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Christian Bachmann
- Department of Child and Adolescent Psychiatry, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
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94
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Carthy E, Ross C, Murphy D. Psychotropic medication prescribing in people with autism spectrum disorders with and without psychiatric comorbidity. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
SUMMARY
Autism spectrum disorders (ASDs) are a group of lifelong neurodevelopmental disorders characterised by difficulties in social interactions and social communication, and restricted and repetitive behaviours. Relative to the general population, individuals with ASDs are likely to be overrepresented in secure psychiatric care and custodial settings. Outcomes vary and can be problematic in the context of co-occurring intellectual disability, psychiatric disorder and challenging behaviours. To date, there is little in the way of specialised clinical guidance on the prescription of psychotropic medicines for individuals with ASDs, particularly information on any differences in efficacy and/or tolerability of specific medications. This review summarises the key research to date on the prescription of psychotropic medication in ASD with and without comorbid psychiatric or neurodevelopmental disorders, within the context of the existing clinical guidance. Some critical analysis is provided to aid clinicians in following a safe, effective and individualised approach to prescribing for people with ASDs.
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Taylor MJ, Ronald A, Martin J, Lundström S, Hosang GM, Lichtenstein P. Examining the association between childhood autistic traits and adolescent hypomania: a longitudinal twin study. Psychol Med 2021; 52:1-10. [PMID: 33827724 DOI: 10.1017/s0033291721000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is evidence that autism spectrum disorders (ASDs) co-occur with bipolar disorder (BD) relatively frequently. Individuals with BD often report symptoms of mania and hypomania during adolescence, prior to the age of onset for BD. It is unknown whether these symptoms are associated with ASDs. We examined whether diagnoses of ASDs and autistic traits were associated with hypomania in a large, population-based Swedish twin sample. METHODS Parental structured interviews assessed autistic traits, and were used to assign screening diagnoses of ASDs, when twins were aged 9 or 12 (N = 13 533 pairs). Parents then completed questionnaires assessing hypomania when the twins were aged 15 and 18 (N = 3852 pairs at age 15, and 3013 pairs at age 18). After investigating the phenotypic associations between these measures, we used the classical twin design to test whether genetic and environmental influences on autistic traits influence variation in adolescent hypomania. RESULTS Autistic traits and ASD diagnoses in childhood were associated with elevated scores on the measures of adolescent hypomania. Twin analyses indicated that 6-9% of the variance in hypomania was explained by genetic influences that were shared with autistic traits in childhood. When repeating these analyses for specific autistic trait domains, we found a stronger association between social interaction difficulties and hypomania than for other autistic trait domains. CONCLUSIONS These results indicate a genetic link between autistic traits and hypomania in adolescence. This adds to the growing evidence base of genetic factors associated with ASDs showing links with psychiatric outcomes across childhood and into adulthood.
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Affiliation(s)
- Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Ronald
- Genes Environment Lifespan Laboratory, Department of Psychological Science, Centre for Brain and Cognitive Development, University of London, Birkbeck, UK
| | - Joanna Martin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Georgina M Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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FASTER and SCOTT&EVA trainings for adults with high-functioning autism spectrum disorder (ASD): study protocol for a randomized controlled trial. Trials 2021; 22:261. [PMID: 33832537 PMCID: PMC8028579 DOI: 10.1186/s13063-021-05205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a chronic neurodevelopmental condition with a prevalence rate above 1%, characterized by deficits in social communication and interaction; restrictive, repetitive patterns of behavior, interests, or activities; and a preference for sameness and routines. The majority of adult ASD patients suffer from comorbid conditions such as depression and anxiety. Therapy options for adult ASD patients are lacking, with presently no available evidence-based interventions in Germany. Recently, two interventions to improve social responsiveness have been published. FASTER ("Freiburger Asperger-Spezifische Therapie für ERwachsene" = Freiburg Asperger-specific therapy for adults) is a manualized group psychotherapy program including three modules on psychoeducation, stress regulation management, and non-verbal and verbal social communication training with videotaped tasks. SCOTT&EVA ("Social Cognition Training Tool", and its enhancement "Emotionen Verstehen und Ausdruecken" = understanding and expressing emotions) is a computer-based training program to enhance social cognition including video and audio material of emotional expressions and complex real-life social situations. Initial studies for both programs have shown good feasibility and efficacy. METHODS Three hundred sixty adult participants with an autism spectrum disorder (ASD) will take part in a randomized controlled three-armed multi-center trial to prove the efficacy of manualized group psychotherapy and a manualized computer-based training program. Both interventions will be compared with a treatment as usual (TAU) group, aiming to establish evidence-based psychotherapy approaches for adult individuals with ASD. The primary outcome is evaluated by parents, spouses, or others who have sufficient insight into the respective participant's social communication and interaction, and will be measured with the Social Responsiveness Scale. First, each of both interventions will be compared to TAU. If at least one of the differences is significant, both interventions will be compared against each other. The primary outcome will be measured at baseline (T0) and 4 months after baseline (T1). DISCUSSION The trial is the first to validate psychiatric therapeutic and training interventions for adult ASD patients in Germany. A trial is needed because the prevalence of ASD in adulthood without intellectual disability is high, and no evidence-based intervention can be offered in Germany. TRIAL REGISTRATION German Clinical Trial Register DRKS00017817 . Registered on 20 April 2020.
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97
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Health Services Use and Costs in Individuals with Autism Spectrum Disorder in Germany: Results from a Survey in ASD Outpatient Clinics. J Autism Dev Disord 2021; 52:540-552. [PMID: 33728496 PMCID: PMC8813793 DOI: 10.1007/s10803-021-04955-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce. Utilisation and annual costs of 385 individuals with ASD (aged 4–67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed. Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs. In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.
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98
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McQuaid GA, Pelphrey KA, Bookheimer SY, Dapretto M, Webb SJ, Bernier RA, McPartland JC, Van Horn JD, Wallace GL. The gap between IQ and adaptive functioning in autism spectrum disorder: Disentangling diagnostic and sex differences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1565-1579. [PMID: 33715473 DOI: 10.1177/1362361321995620] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Adaptive functioning refers to skills that are vital to success in day-to-day life, including daily living (e.g. grocery shopping, food preparation, transportation use), communication (e.g. verbal expression of needs), and socialization skills (e.g. interpersonal skills, including expressing and recognizing emotions, and understanding turn-taking in conversation). Among autistic individuals without intellectual disability, adaptive functioning is not commensurate with intellectual ability (IQ), and instead a gap exists between these individuals' intellectual ability and their adaptive skills. Further, these autistic individuals show a widening of this gap with increasing age. Existing studies of the gap between IQ and adaptive functioning have studied predominantly male samples. Thus, we do not know if the gap also exists in autistic females. We therefore looked at adaptive functioning and the gap between IQ and adaptive functioning in a large sample of autistic girls and boys without intellectual disability. To disentangle effects of group (autistic vs typically developing) from effects of sex (girls vs boys), we compared autistic girls and boys to one another as well as to their same-sex typically developing peers. Analyses took into consideration differences in IQ between autistic and typically developing youth. We found autistic girls, like autistic boys, show lower adaptive functioning than their same-sex typically developing peers. Results underscore the need to evaluate adaptive functioning in autistic individuals without intellectual disability and to provide necessary supports. The large gap between intellectual ability and socialization skills, in particular, may be of critical importance in improving our understanding of outcomes and mental health difficulties among autistic females.
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Affiliation(s)
- Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Kevin A Pelphrey
- Department of Neurology, University of Virginia School of Medicine, Charlottesville VA, USA
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sara J Webb
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - John D Van Horn
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
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99
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Coutelle R, Weiner L, Paasche C, Pottelette J, Bertschy G, Schröder CM, Lalanne L. Autism Spectrum Disorder and Video Games: Restricted Interests or Addiction? Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00511-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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100
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Vegni N, D'Ardia C, Torregiani G. Empathy, Mentalization, and Theory of Mind in Borderline Personality Disorder: Possible Overlap With Autism Spectrum Disorders. Front Psychol 2021; 12:626353. [PMID: 33643157 PMCID: PMC7909009 DOI: 10.3389/fpsyg.2021.626353] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicoletta Vegni
- Faculty of Psychology, Niccolò Cusano University, Rome, Italy
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