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Hull L, Stark I, Lundberg M, Ahlqvist VH, Nordström SI, Ohlis A, Hadlaczky G, Rai D, Magnusson C. Sex differences in self-harm and suicide in young autistic adults. Acta Psychiatr Scand 2024; 150:223-233. [PMID: 39030828 DOI: 10.1111/acps.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION Both suicide and self-harm are disproportionately common in autistic people. Sex differences in risk of self-harm and suicide are observed in the general population, but findings are mixed for autistic people. Self-cutting may be a particularly risky self-harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self-harm in the association between self-harm and suicide in autistic and non-autistic adolescents and young adults. METHODS We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self-harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self-harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self-harm and autism in females and males. RESULTS We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non-autistic individuals (1,286,481 female; 1,341,901 male) aged 12-37 years. Incidence of suicide following self-harm was higher in autistic males (incidence per 100,000 risk-years = 169.0 [95% CI 135.1, 211.3]) than females (125.4 [99.4, 158.3]). The relative risk was higher for autistic females (HR 26.1 [95% CI 20.2, 33.7]) than autistic males (12.5 [9.9, 15.8]). An additive effect of both autism and self-harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self-harmed through cutting were at greatest risk of death from suicide (HR 25.1 [17.9, 35.2]), compared to other methods. CONCLUSION Autistic males and females are at increased risk of death from suicide following severe self-harm, particularly self-cutting.
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Affiliation(s)
- Laura Hull
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isidora Stark
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Selma Idring Nordström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden
| | - Anna Ohlis
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Gergö Hadlaczky
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dheeraj Rai
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- Bristol Autism Spectrum Service, Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Levin C, Nenninger S, Freundlich D, Glatt S, Sokol Y. How future self-continuity mediates the impact of job loss on negative mental health outcomes among transitioning veterans. MILITARY PSYCHOLOGY 2024; 36:491-503. [PMID: 37252891 PMCID: PMC11407375 DOI: 10.1080/08995605.2023.2215697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
Veterans in the transition stage out of the military have an increased risk for negative mental health outcomes and suicide. Previous research has found that finding and retaining employment is the most challenging post-service adjustment for veterans. Job loss may have a greater impact on mental health for veterans than for civilians due to the myriad challenges often faced when transitioning to the civilian workplace, as well as preexisting vulnerabilities that are common among veterans such as trauma exposure or service-related injuries. Previous studies have demonstrated that low Future Self-Continuity (FSC), which refers to the sense of "psychological connectedness" that a person has between their present and future selves, has also been associated with the abovementioned mental health outcomes. 167 U.S. military veterans who exited the military 10 or fewer years prior to their participation in the study, of which 87 experienced subsequent job loss, completed a series of questionnaires to assess future self-continuity (FSC) and mental health outcomes. Results confirmed previous findings in that job loss, as well as low FSC, were individually associated with an increased risk for negative mental health outcomes. Findings suggest that FSC may act as a mediator, where levels of FSC mediate the effects of job loss on negative mental outcomes (depression, anxiety, stress, and suicidality) among veterans during their first 10 years out of the military. These findings may have implications for enhancing current clinical interventions for veterans experiencing job loss and mental health difficulties during the transition period.
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Affiliation(s)
- Chynna Levin
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | | | - Devora Freundlich
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | - Sofie Glatt
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | - Yosef Sokol
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
- Department of Psychology, School of Health Sciences, Touro University, New York, New York
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Deakin M, Petty S, Heasman B, Hamilton LG. A critical reflection on definitions of autistic well-being. Brain Behav 2024; 14:e3572. [PMID: 38945821 PMCID: PMC11214870 DOI: 10.1002/brb3.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/26/2024] [Accepted: 05/14/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- M. Deakin
- School of Education, Language and PsychologyYork St John UniversityYorkUK
| | - S. Petty
- School of Education, Language and PsychologyYork St John UniversityYorkUK
| | - B. Heasman
- School of Education, Language and PsychologyYork St John UniversityYorkUK
| | - L. G. Hamilton
- School of Education, Language and PsychologyYork St John UniversityYorkUK
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Rodgers J, Cassidy S, Pelton M, Goodwin J, Wagnild J, Bhattarai N, Gordon I, Wilson C, Heslop P, Ogundimu E, O’Connor RC, Ramsay SE, Townsend E, Vale L. Feasibility and acceptability of autism adapted safety plans: an external pilot randomised controlled trial. EClinicalMedicine 2024; 73:102662. [PMID: 38864075 PMCID: PMC11165343 DOI: 10.1016/j.eclinm.2024.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background Autistic people are a high-risk group for self-harm and suicide. There are no evidence-based suicide prevention interventions developed specifically for autistic people. We undertook a pilot feasibility randomised controlled trial of autism adapted safety plans (AASP) to reduce self-harm and suicide for autistic people. Methods This study took place in the United Kingdom and followed a randomised, two-arm, controlled design. Autistic adults (n = 53, mean age = 39, gender = 49% female, 29% not male or female) were recruited via third sector organisations and self-referral between 11.8.21 and 19.10.22. Participants were randomised without stratification to usual care with or without AASP. The AASP was completed by the autistic adults together with someone trained to support them. Research staff who completed follow-up assessments were blind to participant allocation. Primary outcomes were feasibility and acceptability. Participants were assessed at baseline, 1 and 6 months. Primary data were analysed under the intention to treat principle. Study protocol is published. The trial is closed to new participants. This study is registered with the ISRCTN registry, ISRCTN70594445. Findings 53 participants consented, 49 were randomised to either AASP with usual care (n = 25) or usual care (n = 24). 68% of participants in the AASP arm were satisfied with the AASP and 41% rated it as useable. Feedback on the AASP and research methods were positive with suggested adaptations to some outcome measures. Retention and completion of outcomes measures in both arms was excellent, as was fidelity of delivery of the AASP. Interpretation Study progression criteria were met, suggesting that the parameters of a future definitive trial of clinical and cost effectiveness of AASP to reduce self-harm and suicide in autistic adults are achievable, with minor recommended adaptions to outcome measures and AASP. Future research should explore the use of AASP in routine clinical practice. Funding This study is funded by the NIHR [Public Health Research Programme (NIHR129196)].
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Affiliation(s)
- Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Mirabel Pelton
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
- Autism Research Centre, University of Cambridge, UK
| | - Jane Goodwin
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | | | - Nawaraj Bhattarai
- Health Economics Group, Population Health Science Institute, Newcastle University, NE1 7RU, UK
| | - Isabel Gordon
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Phil Heslop
- Social Work, Education and Community Wellbeing, Northumbria University, NE7 7XA, UK
| | | | - Rory C. O’Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, G12 8TB, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Luke Vale
- Health Economics Group, Population Health Science Institute, Newcastle University, NE1 7RU, UK
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Thiel T, Riedelbauch S, Gaigg S, Roessner V, Ring M. The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum. Autism Res 2024; 17:1161-1174. [PMID: 38783834 DOI: 10.1002/aur.3144] [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: 07/24/2022] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.
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Affiliation(s)
- Tobias Thiel
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Saskia Riedelbauch
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Sebastian Gaigg
- Autism Research Group, Department of Psychology, City, University of London, London, UK
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Melanie Ring
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
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6
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McKernan EP, Russo N. Investigating the Structure of the CESD-R and DASS-21 Across Adults with Low and High Levels of Autistic Traits. J Autism Dev Disord 2024; 54:2026-2039. [PMID: 36959520 DOI: 10.1007/s10803-023-05944-5] [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] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
The current study examined factorial invariance of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Depression Anxiety Stress Scales-21 (DASS-21) using a convenience sample of 434 adults surveyed though Amazon Mechanical Turk. Participants were sorted into two groups based on their score on the Autism-Spectrum Quotient. Results indicated that the CESD-R did not demonstrate configural invariance. The DASS-21 demonstrated evidence of scalar invariance, indicating cross-group equality in factor loadings and factor intercepts. Findings suggest that the DASS-21 measures symptoms of depression, anxiety, and stress consistently across individuals with high and low levels of ASD-related traits, whereas the CESD-R may not be valid when assessing symptoms of depression in those with a high level of ASD-related traits.
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Affiliation(s)
- Elizabeth P McKernan
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie Russo
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
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Newell V, Townsend E, Richards C, Cassidy S. Measurement properties of tools used to assess self-harm in autistic and general population adults. Clin Psychol Rev 2024; 109:102412. [PMID: 38503029 DOI: 10.1016/j.cpr.2024.102412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Autistic people are at increased risk of experiencing self-harm compared to the general population. However, it is unclear which tools are being used to assess self-harm in autistic people, or whether existing tools need to be adapted for this group. This two-stage systematic review aimed to identify tools used to assess self-harm in autistic and general population adults, evaluate these tools on their measurement properties, and make recommendations for their appropriate use in research and clinical practice. Four databases were systematically searched (PsycINFO, Embase, MEDLINE and Web of Science). Eight frequently used self-harm assessment tools were identified and assessed for risk of bias, criteria for good measurement properties, and quality of evidence using the COSMIN checklist. Of these, two tools had sufficient evidence of internal consistency (ISAS, QNSSI), and one had been frequently used with autistic adults (NSSI-AT). These three tools may have potential for use with autistic adults but require further investigation for content validity and measurement properties in the autistic population. More research and potential adaptations to current self-harm assessment tools are recommended in order to better conceptualise and understand self-harm and its measurement in autism.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom.
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham B15 2TT, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
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8
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Schiltz HK, Williams ZJ, Zheng S, Kaplan-Kahn EA, Morton HE, Rosenau KA, Nicolaidis C, Sturm A, Lord C. Measurement matters: A commentary on the state of the science on patient reported outcome measures (PROMs) in autism research. Autism Res 2024; 17:690-701. [PMID: 38429884 DOI: 10.1002/aur.3114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
High quality science relies upon psychometrically valid and reliable measurement, yet very few Patient Reported Outcome Measures (PROMs) have been developed or thoroughly validated for use with autistic individuals. The present commentary summarizes the current state of autism PROM science, based on discussion at the Special Interest Group (SIG) at the 2022 International Society for Autism Research (INSAR) Annual Meeting and collective expertise of the authors. First, we identify current issues in autism PROM research including content and construct operationalization, informant-structure, measure accessibility, and measure validation and generalization. We then enumerate barriers to conducting and disseminating this research, such as a lack of guidance, concerns regarding funding and time, lack of accessible training and professionals with psychometric skills, difficulties collecting large representative samples, and challenges with dissemination. Lastly, we offer future priorities and resources to improve PROMs in autism research including a need to continue to evaluate and develop PROMs for autistic people using robust methods, to prioritize diverse and representative samples, to expand the breadth of psychometric properties and techniques, and to consider developing field specific guidelines. We remain extremely optimistic about the future directions of this area of autism research. This work is well positioned to have an immense, positive impact on our scientific understanding of autism and the everyday lives of autistic people and their families.
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Affiliation(s)
- Hillary K Schiltz
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, Universtiy of California San Francisco, San Francisco, California, USA
| | - Elizabeth A Kaplan-Kahn
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah E Morton
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Kashia A Rosenau
- Department of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | - Christina Nicolaidis
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- School of Social Work, Portland State University, Portland, Oregon, USA
| | - Alexandra Sturm
- Department of Psychological Science, Loyola Marymount University, Los Angeles, California, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles, USA
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Robeson M, Brasil KM, Adams HC, Zlomke KR. Measuring depression and anxiety in autistic college students: A psychometric evaluation of the PHQ-9 and GAD-7. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241240183. [PMID: 38514920 DOI: 10.1177/13623613241240183] [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: 03/23/2024]
Abstract
LAY ABSTRACT Anxiety, depression, and suicidality are major concerns among college students, though less is known about these constructs in autistic college students. Given the rising number of autistic individuals entering college, adequate screening and diagnosis of mental health difficulties is necessary to provide care to this population. For example, despite widespread usage of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), it is unknown if the two instruments accurately measure depression and anxiety the same way between non-autistic and autistic individuals. Thus, the current study was the first to examine how these instruments measure depression and anxiety symptoms in autistic versus non-autistic college students. Utilizing tests of construct measurement in a sample of autistic (n = 477) and non-autistic (n = 429) university students aged 18-29, results showed that while the GAD-7 and PHQ-9 appear to be accurately capturing anxiety and depression in autistic college students, the PHQ-9 item assessing suicidality was found to be measuring different things. This indicates that autistic college students are not interpreting this question the way non-autistic students are, and thus, the measure is failing to capture suicidality in autistic people. Future investigators should continue to assess the appropriateness of using common screening measures, originally created by non-autistic people, in autistic populations.
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Thomas HR, Sirsikar A, Eigsti IM. Brief Report: Convergence and Discrepancy Between Self- and Informant-Reported Depressive Symptoms in Young Autistic Adults. J Autism Dev Disord 2024:10.1007/s10803-023-06230-0. [PMID: 38231383 DOI: 10.1007/s10803-023-06230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Autistic individuals exhibit elevated rates of depression; however, assessment is complicated by clinical presentations and limited validation in this population. Recent work has demonstrated the utility of the Beck Depression Inventory (BDI-II) in screening for depression in ASD. The current study extends this work by examining the convergence and divergence of self- and informant-reported depression in autistic (n = 258) and non-autistic (n = 255) young adults. METHODS Participants completed the BDI-II as a self-report measure of depression; informants completed the Achenbach Adult Behavior Checklist. Analyses probed for between-group differences in rates of depression symptoms, convergence between self- and informant-reported depression, and discrepancy between self- and informant-reported depression. RESULTS Results indicated significantly higher rates of depressive symptoms in the autistic group. Convergence was significant in both groups, with significantly greater agreement in the autistic group. There was differential divergence, with the autistic group reporting significantly lower scores relative to informants, and the non-autistic group reporting significantly higher scores relative to informants. CONCLUSIONS Consistent with prior reports, results suggest that depression rates are elevated in autism. Additionally, while the BDI-II may be adequate for screening depressive symptoms in speaking autistic young adults, eliciting information from a close adult informant provides valuable diagnostic information, due to clinically critical concerns about underreporting in this population. Although controlled in analyses, between-group differences in gender, age, race, and informant identity, and a predominantly White and non-Latinx sample, limit the generalizability of these results.
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Affiliation(s)
- Hannah R Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Aditi Sirsikar
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
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Brown KA, Donise KR, Cancilliere MK, Aluthge DP, Chen ES. Characterizing Autism Spectrum Disorder and Predicting Suicide Risk for Pediatric Psychiatric Emergency Services Encounters. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:864-873. [PMID: 38222397 PMCID: PMC10785882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Individuals diagnosed with autism spectrum disorder (ASD) are at a higher risk for mental health concerns including suicidal thoughts and behaviors (STB). Limited studies have focused on suicidal risk factors that are more prevalent or unique to the population with ASD. This study sought to characterize and classify youth presenting to the psychiatric emergency department (ED) for a chief complaint of STB. The results of this study validated that a high number of patients with ASD present to the ED with STB. There were important differences in clinical characteristics to those with ASD versus those without. Clinical features that showed important impact in predicting high suicide risk in the ASD cases include elements of the mental status exam such as affect, trauma symptoms, abuse history, and auditory hallucinations. Focused attention is needed on these unique differences in ASD cases so that suicide risk level can be appropriately and promptly addressed.
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Affiliation(s)
| | - Kathleen R Donise
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Mary Kathryn Cancilliere
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Dilum P Aluthge
- Center for Biomedical Informatics, Brown University, Providence RI
| | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence RI
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12
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Arnold SR, Higgins JM, Weise J, Desai A, Pellicano E, Trollor JN. Towards the measurement of autistic burnout. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1933-1948. [PMID: 36637292 DOI: 10.1177/13623613221147401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
LAY ABSTRACT Autistic burnout has been talked about by autistic adults for some time on blogs and in social media. Now, research describes fatigue, exhaustion and other related symptoms experienced by autistic people. We need new ways to help identify autistic burnout. In this study, we tested a new questionnaire called the AASPIRE Autistic Burnout Measure, and we investigated things that are linked to worse autistic burnout. We also trialled a group of Autistic Burnout Severity Items that we made. Working with an autistic researcher, we made the Autistic Burnout Severity Items based on published definitions of autistic burnout. Autistic adults (n = 141) who had experienced autistic burnout completed an online survey. We found that autistic burnout was connected to masking and depression. The Autistic Burnout Measure tool was associated with depression but not with masking. It was not very accurate in telling apart participants who were currently experiencing burnout versus those who were reporting on their past experience. The Autistic Burnout Severity Items might have problems with subscales adding together to measure autistic burnout. More work is needed on how to measure autistic burnout. Our research and other recent studies show autistic people experience a combination of exhaustion, withdrawal and problems with their concentration and thinking. Burnout seems to be linked to the stress experienced by autistic people in their daily lives. We need more research to understand the difference between autistic burnout and other conditions and experiences. We need to develop assessment tools that can help identify this burnout.
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Affiliation(s)
- Samuel Rc Arnold
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Julianne M Higgins
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | | | | | - Elizabeth Pellicano
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Macquarie University, Australia
| | - Julian N Trollor
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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Angel L, Ailey SH, Delaney KR, Mohr L. Presentation of Depressive Symptoms in Autism Spectrum Disorders. West J Nurs Res 2023; 45:854-861. [PMID: 37586013 DOI: 10.1177/01939459231190269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Depressive disorders are frequently mis- and underdiagnosed in individuals with autism spectrum disorders (ASD). OBJECTIVE Our objective was to identify and synthesize current knowledge regarding (1) the presentation of depressive symptoms and (2) the use of self-reports in assessing depressive symptoms in individuals with ASD and comparisons between self-reported and observer-reported symptoms. A scoping review was conducted to capture the full range of literature on the topic and to identify research gaps. METHODS Articles were identified through a search of academic literature and screened for relevance to the aims of the review. RESULTS In addition to typical depression symptoms, individuals with ASD may demonstrate atypical symptoms such as changes in autistic symptoms, self-injurious behavior, and psychomotor changes. Moreover, the review revealed a bias toward observer-reports of symptoms. Self-reports frequently were not included or were ascribed less weight than observer-reports. Self-reports typically differed from reports given by parents or other caregivers, but a consistent pattern in these differences has not been established. CONCLUSIONS Further research on the use of self-reports in assessing depressive symptoms in individuals with ASD is needed. Self-reports may provide information not obtainable through observer-reports, and integrating both self- and observer-reports in psychiatric evaluations may produce more comprehensive and accurate assessments.
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Affiliation(s)
- Lisa Angel
- College of Nursing, Rush University, Chicago, IL, USA
| | - Sarah H Ailey
- Community, Systems, and Mental Health Nursing, Rush University, Chicago, IL, USA
| | - Kathleen R Delaney
- Community, Systems, and Mental Health Nursing, Rush University, Chicago, IL, USA
| | - Lynn Mohr
- Women and Children College of Nursing, Rush University, Chicago, IL, USA
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15
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Stacey R, Cage E. "Simultaneously Vague and Oddly Specific": Understanding Autistic People's Experiences of Decision Making and Research Questionnaires. AUTISM IN ADULTHOOD 2023; 5:263-274. [PMID: 37663447 PMCID: PMC10468547 DOI: 10.1089/aut.2022.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Autism researchers often use questionnaires to gather the views and experiences of autistic people. However, questionnaires may not always be designed in accessible ways. In addition, answering questions within a questionnaire involves decision making, which some autistic people have reported finding difficult. Therefore, this exploratory study aimed to enhance our understanding of autistic people's experiences of decision making, and to analyze their feedback on questionnaire measures to further understand decision making within the research context. Methods One hundred seventeen participants completed an online questionnaire. In the questionnaire, they answered an open question about what affected their ability to make decisions. They then completed four questionnaire measures and after each one provided feedback. We used content analysis to categorize participants' qualitative answers. Results Participants discussed how their internal state, other people, the quality and quantity of information, pressure on choosing a response, external distractions, and lack of time all affected their decision making. Feedback on the questionnaires highlighted how questions needed context, often questions themselves were unclear and difficult to understand, that there were issues with Likert scales, and how measures could have questionable validity for autistic people. Conclusions Autism researchers need to consider how they can make their research as accessible as possible for autistic people. Our study highlights how decision making is not a straight-forward process, and researchers have a role in ensuring they give their participants clear and contextualized information. Involving autistic people in the design of research is a potential way of improving the quality of research.
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Affiliation(s)
- Rachael Stacey
- Department of Psychology, University of Stirling, Stirling, Scotland
| | - Eilidh Cage
- Department of Psychology, University of Stirling, Stirling, Scotland
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16
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Cassidy S, McLaughlin E, McGranaghan R, Pelton M, O'Connor R, Rodgers J. Is camouflaging autistic traits associated with defeat, entrapment, and lifetime suicidal thoughts? Expanding the Integrated Motivational Volitional Model of Suicide. Suicide Life Threat Behav 2023; 53:572-585. [PMID: 37129164 DOI: 10.1111/sltb.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The current study explored whether camouflaging autistic traits is associated with defeat and entrapment and lifetime suicidal thoughts, as predicted by the Integrated Volitional Model of Suicide (IMV model). METHODS 180 UK undergraduate students (76.7% female 18-67 years) completed a cross-sectional online survey from February 5 to March 23, 2020, including self-report measures of defeat and entrapment (SDES), autistic traits (AQ-10), depression (PHQ-9), anxiety (GAD-7), camouflaging autistic traits (CAT-Q), and lifetime suicidal thoughts and behaviors (SBQ-R item 1). RESULTS After controlling for age, gender, current depression, and anxiety symptoms, autistic traits accounted for significantly more of the variance in defeat and entrapment (1.1%), and camouflaging accounted for a further 3.2% of the variance. The association between autistic traits and lifetime suicidality was significantly mediated by camouflaging, defeat, and entrapment. After controlling for age, gender, current depression, and anxiety symptoms, defeat and entrapment (but not camouflaging) accounted for significantly more variance in lifetime suicidal thoughts. The interaction between camouflaging, defeat and entrapment predicted significantly less variance in lifetime suicidal thoughts than either variable alone. CONCLUSION Results suggest that camouflaging autistic traits is a transdiagnostic risk factor for lifetime suicidality, relevant to the defeat and entrapment constructs of the IMV model.
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Affiliation(s)
- Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | | | - Mirabel Pelton
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rory O'Connor
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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17
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Curnow E, Rutherford M, Maciver D, Johnston L, Prior S, Boilson M, Shah P, Jenkins N, Meff T. Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS One 2023; 18:e0288275. [PMID: 37440543 PMCID: PMC10343158 DOI: 10.1371/journal.pone.0288275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Autistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community. OBJECTIVE This rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570). DATA SOURCES MEDLINE, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY CRITERIA English language; published 2011-2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults. APPRAISAL AND SYNTHESIS Bias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation. RESULTS Twenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as 'evidence based.' Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered. CONCLUSIONS There is some understanding of the scope of mental ill-health in autism, but interventions are not tailored to the needs of autistic adults, not evidence based, and may focus on promoting neurotypical behaviours rather than the priorities of autistic people.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh, United Kingdom
| | - Susan Prior
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marie Boilson
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Fife Health and Social Care Partnership, Lynebank Hospital, Dunfermline, Fife, United Kingdom
| | - Premal Shah
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, United Kingdom
| | - Natalie Jenkins
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Tamsin Meff
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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18
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Pelton MK, Crawford H, Bul K, Robertson AE, Adams J, de Beurs D, Rodgers J, Baron‐Cohen S, Cassidy S. The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis. Suicide Life Threat Behav 2023; 53:426-442. [PMID: 36974940 PMCID: PMC10947106 DOI: 10.1111/sltb.12954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.
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Affiliation(s)
- Mirabel K. Pelton
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kim Bul
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Ashley E. Robertson
- School of Psychology & NeuroscienceUniversity of Glasgow, University AvenueGlasgowUK
| | - Jon Adams
- Autistic Advocate and ResearcherPortsmouthUK
| | | | - Jacqui Rodgers
- Population Health Sciences InstituteSir James Spence Institute, Newcastle University, Royal Victoria InfirmaryNewcastleUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Cassidy
- School of PsychologyUniversity of Nottingham, University ParkNottinghamUK
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19
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Scott M, Leppanen J, Allen M, Jarrold C, Sedgewick F. Longitudinal Analysis of Mental Health in Autistic University Students Across an Academic Year. J Autism Dev Disord 2023; 53:1107-1116. [PMID: 35802290 PMCID: PMC9264293 DOI: 10.1007/s10803-022-05560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autistic people have worse mental health (MH) than non-autistic people. This proof-of-concept study explored feasibility of longitudinal research with autistic university students, focusing on their MH and coping styles across an academic year. METHODS Twenty-two students took part at all timepoints. They completed four rounds of online MH questionnaires. RESULTS Over 80% of students were retained. They started the year with high levels of all MH issues, which remained stable across the year. Network Change analysis showed the connections between MH and coping style changed over time. CONCLUSIONS Autistic students are engaged participants who are likely to take part in longitudinal research. While MH levels were stable, it may be that coping styles are a useful target for intervention.
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Affiliation(s)
- Matthew Scott
- School of Education, University of Bristol, Bristol, UK.,School of Psychology, University of Cardiff, Cardiff, UK
| | - Jenni Leppanen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Melissa Allen
- School of Education, University of Bristol, Bristol, UK
| | - Chris Jarrold
- School of Psychological Science, University of Bristol, Bristol, UK
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20
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A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clin Psychol Rev 2023; 99:102235. [PMID: 36459876 DOI: 10.1016/j.cpr.2022.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.
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21
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Brooker H, Charlton RA, Happé F. The cognitive profile of middle-aged and older adults with high vs. low autistic traits. Autism Res 2023; 16:429-440. [PMID: 36454212 PMCID: PMC10947177 DOI: 10.1002/aur.2866] [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: 11/30/2021] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
Cognitive differences in memory, information processing speed (IPS), and executive functions (EF), are common in autistic and high autistic trait populations. Despite memory, IPS and EF being sensitive to age-related change, little is known about the cognitive profile of older adults with high autistic traits. This study explores cross-sectional memory, IPS and EF task performance in a large sample of older adults in the online PROTECT cohort (n = 22,285, aged 50-80 years), grouped by high vs. low autistic traits. Approximately 1% of PROTECT participants (n = 325) endorsed high autistic traits [henceforth Autism Spectrum Trait (AST) group]. Differences between AST and age-, gender-, and education-matched comparison older adults (COA; n = 11,744) were explored on memory, IPS and EF tasks and questionnaires administered online. AST had lower performance than COA on tasks measuring memory, working memory, sustained attention, and information processing. No group differences were observed in simple attention or verbal reasoning. A similar pattern of results was observed when controlling for age, and current depression and anxiety symptoms. In addition, AST self-reported more cognitive decline than COA, but this difference was not significant when controlling for current depression symptoms, or when using informant-report. These findings suggest that autistic traits are associated with cognitive function in middle-aged and later life. Older adults with high autistic traits experienced more performance difficulties in a range of memory, IPS and EF tasks compared with the low autistic traits comparison group. Further longitudinal work is needed to examine age-related change in both older autistic and autistic trait populations.
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Affiliation(s)
- Gavin R. Stewart
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Anne Corbett
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Clive Ballard
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Byron Creese
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Helen Brooker
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Francesca Happé
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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22
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Corbett BA, Muscatello RA, Klemencic ME, West M, Kim A, Strang JF. Greater gender diversity among autistic children by self-report and parent-report. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:158-172. [PMID: 35363085 PMCID: PMC9525458 DOI: 10.1177/13623613221085337] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Gender diversity broadly refers to the way in which an individual experiences (expressions and/or identities) their gender distinctly to that which would be expected based upon social norms for their gender assigned at birth. Recent research has shown a higher representation of gender diversity among autistic youth. Previous research in this area has relied on parent-report based on a single question from the Child Behavior Checklist Item-110, asking whether their child "Wishes to be the opposite sex." The Gender Diversity Screening Questionnaire Self-Report and Parent-Report were used to assess the experience of gender diversity in 244 children (140 autism spectrum disorder and 104 typically developing) between 10 and 13 years. The Item-110 was also collected. Results showed that autistic children endorsed much higher rates of Binary Gender Diversity (less identification with their designated sex and more with the other binary sex) and Nonbinary Gender Diversity (identification as neither male nor female) than typically developing children. Similarly, parents of autistic children reported significantly more gender-body incongruence experienced by their child than parents of typically developing children. Specifically, parents of autistic females-assigned-at-birth reported significantly more gender-body incongruence than autistic males-assigned-at-birth. Parent- and self-report measures were largely related. Moreover, statistical comparisons between and within the groups revealed associations between gender profiles and symptoms of anxiety, depression, and suicidality. Results extend previous reports showing increased rates of gender diversity in autistic children, now based on both self-report and parent-report, and highlight the need to better understand and support the unique and complex needs of autistic children who experience gender diversity.
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Affiliation(s)
- Blythe A. Corbett
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences,Vanderbilt Kennedy Center
| | - Rachael A. Muscatello
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Mark E. Klemencic
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Millicent West
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Ahra Kim
- Vanderbilt University Medical Center, Department of
Biostatistics
| | - John F. Strang
- Gender and Autism Program, Children’s National
Hospital,Departments of Pediatrics, Psychiatry, and Behavioral
Science, George Washington University School of Medicine
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23
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Recommended adaptations to therapy services for autistic adults from specialist clinicians. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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The indirect effect of self-compassion in the association between autistic traits and anxiety/depression: A cross-sectional study in autistic and non-autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221132109. [DOI: 10.1177/13623613221132109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study followed a pre-registered analysis plan with the aim to investigate whether autistic traits and self-compassion are correlated in autistic adults, and to test an indirect effect of autistic traits on anxiety/depression via self-compassion. We present the findings of an online survey of 456 participants ( n = 228 autistic adults, n = 228 non-autistic adults) who completed the Autism Spectrum Quotient (AQ), the Self-Compassion Scale (SCS) and the Hospital Anxiety and Depression Scale (HADS). Lower self-compassion was reported by autistic participants compared to non-autistic participants, and a negative correlation was found between autistic traits and self-compassion in both groups. Furthermore, an indirect association between autistic traits and anxiety/depression via self-compassion was observed in both samples. Considering that many autistic people experience co-occurring anxiety and depression, and that self-compassion is a skill that can be cultivated with practice, the findings of this study suggest that self-compassion may be a modifiable factor that could improve the mental health of this population. Lay abstract Previous research on non-autistic adults suggests self-compassion may serve to reduce mental health problems and promote psychological well-being. Correlations between autistic traits and self-compassion have been observed in non-clinical populations. In this study, we were interested in extending previous research by exploring relationships between autistic traits, self-compassion and anxiety/depression in autistic adults without intellectual disability. The findings revealed that on average autistic people reported lower self-compassion than non-autistic people. Once we accounted for levels of self-compassion in our statistical model, this resulted in a complete loss of statistical significance in the relationships between autistic traits and anxiety/depression. Self-compassion may be a useful target for clinical intervention in autistic adults with co-occurring mental health difficulties.
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25
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Hedley D, Batterham PJ, Bury SM, Clapperton A, Denney K, Dissanayake C, Fox P, Frazier TW, Gallagher E, Hayward SM, Robinson J, Sahin E, Trollor J, Uljarević M, Stokes MA. The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1115-1131. [PMID: 36237153 DOI: 10.1177/13623613221131234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jo Robinson
- The University of Melbourne, Australia.,Orygen, Australia
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26
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Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum's capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.
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Affiliation(s)
- Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Unsa Fatima
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Gabrielle Hall
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Melanie Heyworth
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
- Reframing Autism, Sydney, New South Wales Australia
| | - Wenn Lawson
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Rozanna Lilley
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Joanne Mahony
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Marc Stears
- UCL Policy Lab, University College London, London, UK
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Golan O, Terner M, Israel-Yaacov S, Allison C, Baron-Cohen S. The Autism-Spectrum Quotient-Hebrew version: Psychometric properties of a full and a short form, adapted for DSM-5. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:796-807. [PMID: 36053012 PMCID: PMC10074759 DOI: 10.1177/13623613221117020] [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: 11/16/2022]
Abstract
LAY ABSTRACT Despite the attempt to diagnose autism at an early age, there are still many individuals who would only get an autism diagnosis in adulthood. For these adults, a questionnaire that could assist in highlighting their need to seek diagnostic assessment is needed. The Autism-Spectrum Quotient is a self-report scale used to assess autistic traits. It was tested cross-culturally, and a short version was recommended to help identify adults who should be referred for an autism assessment. However, its relevance for the up-to-date diagnostic criteria, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), has not been tested. This study aimed to examine the psychometric properties of the Hebrew version of the Autism-Spectrum Quotient and to create a short version of the Hebrew Autism-Spectrum Quotient, based on items which map on to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Ninety-three autistic adults (24 females), aged 18-51, clinically diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and 147 comparable controls (34 females) filled out the Hebrew version of the Autism-Spectrum Quotient. Ten clinicians who specialize in diagnosing autism in adults classified the Autism-Spectrum Quotient's items according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. The short version of the Hebrew Autism-Spectrum Quotient comprised items that best differentiated between adults with and without autism, five items representing each of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic domains. The overall probability for participants to be correctly classified as autistic or neurotypical was 86% for the Hebrew version of the Autism-Spectrum Quotient and 88% for the short version of the Hebrew Autism-Spectrum Quotient. We conclude that both versions are reliable and sensitive instruments that can help referring adults for autism assessment.
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Affiliation(s)
- Ofer Golan
- Bar-Ilan University, Israel.,Association for Children at Risk, Israel.,University of Cambridge, UK
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28
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Olsson P, Wiktorsson S, Strömsten LMJ, Salander Renberg E, Runeson B, Waern M. Attention deficit hyperactivity disorder in adults who present with self-harm: a comparative 6-month follow-up study. BMC Psychiatry 2022; 22:428. [PMID: 35751076 PMCID: PMC9233312 DOI: 10.1186/s12888-022-04057-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months. METHODS Eight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register. RESULTS Recent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05-2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder. CONCLUSIONS Findings highlight the need for clinicians to take self-harm seriously in adults with ADHD.
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Affiliation(s)
- Petter Olsson
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45, Göteborg, Sweden.
| | - Stefan Wiktorsson
- grid.8761.80000 0000 9919 9582Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45 Göteborg, Sweden ,grid.1649.a000000009445082XRegion Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
| | - Lotta M. J. Strömsten
- grid.12650.300000 0001 1034 3451Department of Psychology, Umeå University, Umeå, Sweden
| | - Ellinor Salander Renberg
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Bo Runeson
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Margda Waern
- grid.8761.80000 0000 9919 9582Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45 Göteborg, Sweden ,grid.1649.a000000009445082XRegion Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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Radoeva PD, Ballinger K, Ho T, Webb SJ, Stobbe GA. Brief Report: Risk and Protective Factors Associated with Depressive Symptoms among Autistic Adults. J Autism Dev Disord 2022; 52:2819-2824. [PMID: 34189682 PMCID: PMC10027384 DOI: 10.1007/s10803-021-05085-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Autistic individuals are at risk for developing depression though the risk and protective factors for co-occurring depression in autistic individuals are not yet fully characterized. In this retrospective medical chart review study, we explored factors associated with self-reported depressive symptoms (Patient Health Questionnaire-9) in autistic adults (N = 58). For autistic adults, engagement in one or more activities (recreational, educational and/or vocational) was associated with less severe depressive symptoms (Mann-Whitney U test, p = 0.006); and reported family history of depression/anxiety was associated with increased likelihood of suicidal ideation (Chi-square test, p = 0.027). Promotion of community-based activities and family support systems may be an integral part of creating effective treatment plans for depressive symptoms in autistic adults.
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Affiliation(s)
- Petya D Radoeva
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Emma Pendleton Bradley Hospital, East Providence, RI, USA.
| | - Kristen Ballinger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Theodore Ho
- Seattle Children's Autism Center, Seattle, WA, USA
| | - Sara J Webb
- Seattle Children's Autism Center, Seattle, WA, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Gary A Stobbe
- Seattle Children's Autism Center, Seattle, WA, USA
- Adult Autism Clinic, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
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Oakley BFM, Jones EJH, Crawley D, Charman T, Buitelaar J, Tillmann J, Murphy DG, Loth E. Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychol Med 2022; 52:1458-1470. [PMID: 33028432 PMCID: PMC9226426 DOI: 10.1017/s0033291720003244] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood. METHODS In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms. RESULTS Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62). CONCLUSIONS Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.
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Affiliation(s)
- Bethany F. M. Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Emily J. H. Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London WC1E 7HX, UK
| | - Daisy Crawley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Reiner Postlaan 12, Nijmegen, The Netherlands
| | - Julian Tillmann
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Applied Psychology: Health, Development, Enhancement, and Intervention, University of Vienna, Vienna, Austria
| | - Declan G. Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. Self-harm and Suicidality Experiences of Middle-Age and Older Adults With vs. Without High Autistic Traits. J Autism Dev Disord 2022:10.1007/s10803-022-05595-y. [PMID: 35616817 DOI: 10.1007/s10803-022-05595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
Suicide has been identified as a leading cause of premature death in autistic populations. Elevated autistic traits have also been associated with higher rates of self-harm, suicidal ideation, and suicidal self-harm in the general population, but this has yet to be examined in older age. Using baseline cross-sectional data from the PROTECT study, middle-age and older adults with high autistic traits (n = 276) had significantly higher rates of suicidal ideation, deliberate self-harm, and suicidal self-harm than an age/sex-matched comparison group (n = 10,495). These differences represented a 5- to 6-fold increase in likelihood for self-harming and suicidality. These findings, which remained when controlling for depression symptoms, suggest that middle-age and older adults with high autistic traits may be particularly at risk of self-harm and suicidal behaviours.
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Affiliation(s)
- Gavin R Stewart
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Dag Aarsland
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Adam Hampshire
- Department of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Rebecca A Charlton
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
| | - Francesca Happé
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
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Stewart TM, Martin K, Fazi M, Oldridge J, Piper A, Rhodes SM. A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychol Psychother 2022; 95:313-344. [PMID: 34605156 DOI: 10.1111/papt.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.
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Affiliation(s)
- Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, UK
| | | | | | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
| | - Allan Piper
- Child and Adolescent Mental Health, NHS Lothian, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
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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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Pilunthanakul T, Goh TJ, Fung DSS, Sultana R, Allen JC, Sung M. Validity of the patient health questionnaire 9-item in autistic youths: a pilot study. BMC Psychiatry 2021; 21:564. [PMID: 34772391 PMCID: PMC8588623 DOI: 10.1186/s12888-021-03556-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Autistic adolescents have greater predisposition to depression and suicidality than neurotypical adolescents. Early detection is essential for timely treatment. The Patient Health Questionnaire 9-item (PHQ-9) is a brief screen for depression. The study examines the validity of the PHQ-9 for detecting major depressive disorder (MDD) in autistic youths. METHODS English speaking youths aged 10-18 years, with DSM-IV/DSM-5/ICD-10 diagnosis of Autism Spectrum Disorder (ASD), and their parents presenting to a child psychiatric service were invited to participate between May 2018 to August 2020. Participants completed the respective self- and parent-rated PHQ-9 independently. MDD was verified using the MINI-Kid (Mini-International Neuropsychiatric Interview, Kid version). RESULTS One hundred one youth, mean (SD) age 14.6 (2.3), were enrolled. 27 (27%) met criteria for current MDD. Mean total PHQ-9 scores, percentage ratings for severity of symptoms of depression, functional impairment, dysthymia and suicidality were compared. Areas under the ROC curve and statistically optimal cutoffs were determined. Parents rated depressive symptoms severity lower than their children. The PHQ-9 displayed low sensitivity with high false negative rates at conventional, adjusted and proposed cutoffs. CONCLUSIONS Future studies should improve on the validity and reliability of existing depression screening tools, or develop more appropriate screening methods of depression, for autistic youths.
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Affiliation(s)
- Thanita Pilunthanakul
- Ministry of Health, 16 College Rd, College of Medicine Building, Singapore, 169854, Singapore.
| | - Tze Jui Goh
- grid.414752.10000 0004 0469 9592Department of Child & Adolescent Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Child & Adolescent Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Rehena Sultana
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, l8 College Rd, Singapore, 169857 Singapore
| | - John Carson Allen
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, l8 College Rd, Singapore, 169857 Singapore
| | - Min Sung
- grid.414752.10000 0004 0469 9592Department of Child & Adolescent Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
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Abstract
INTRODUCTION Ireland has an ageing population of persons with intellectual disability (ID), autism spectrum disorder (ASD) and both (ID/ASD). Despite this, little is known about the prevalence of ASD and its effect on functional outcomes, psychiatric comorbidity or diagnostic issues in an older population with ID. This article reviews the literature on older adults with ID/ASD and identifies opportunities for future research in this population. METHOD The authors searched the Medline, Pubmed, Embase, CINAHL and PsychInfo databases using the search terms using key words: (older adults) AND (ID OR mental retardation OR learning disability) AND (autism OR ASD). After excluding articles for relevance, a scoping review was carried out on the results retrieved. RESULTS Of the 1227 articles retrieved from the literature on ID and autism/ASD in older adults, 85 articles were relevant to an adult population with ID/ASD. The data were collated and are presented covering domains of diagnosis, prevalence, psychiatric comorbidities and functional outcomes. CONCLUSIONS Despite increased prevalence in childhood ASD in the last 20 years, there is a lack of research regarding adults, especially older adults, with ASD, up to half of whom will have some level of ID. The existing literature suggests that older adults with ID/ASD may have reduced functional independence, increased psychiatric comorbidity and psychotropic prescribing and more behavioural presentations than the older population generally or those with ID only. There is a need for longitudinal data to be collected on this ageing population so that care and management needs can be met in the future.
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Valicenti-McDermott M, Rivelis E, Bernstein C, Cardin MJ, Seijo R. Screening for Depression in Adolescents with Developmental Disabilities: Brief Report. J Child Adolesc Psychopharmacol 2021; 31:572-576. [PMID: 34582695 DOI: 10.1089/cap.2021.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: (1) To examine adherence of universal screening for adolescent depression at initial visits by using an established screening instrument (Patient Health Questionnaire 9 [PHQ-9]) in a university-affiliated urban developmental center that serves children with developmental disabilities (DDs); (2) to study the frequency of positive screening for depression in adolescents with DD. Methods: Review of all adolescents referred for multidisciplinary evaluation in a developmental center in 2019. Data included demographics, DD diagnoses, and use of and scores on the PHQ-9 at initial visit. Statistics included chi-square and non-parametrics. Results: Of all the children evaluated in 2019 (n = 240), 52 were adolescents, 35 boys (63%)/17 girls (37%), age 14 ± 2 years old, and 27 (54%) belonging to a bilingual English-Spanish household. DD: Developmental Language Disorder (88%), Learning Disabilities (54%), attention-deficit/hyperactivity disorder (44%), Autism Spectrum Disorder (25%), Intellectual Disabilities (12%), and Phonological Disorder (8%). The PHQ-9 was administered to 30 (58%) individuals. Scores varied from minimal depression for 17 (57%), mild for 10 (33%), and moderate and severe for 3 (10%); 3 patients endorsed suicidality. Females were more likely to obtain higher scores on the PHQ-9 than males. Adolescents diagnosed with Autism Spectrum Disorder, Intellectual Disabilities, and Phonological Disorder were less likely to be screened. Conclusion: More than half of the sample of urban adolescents with DD were screened for depression at initial visit, and 10% screened positive for moderate to severe depression. Efforts to follow the U.S. Preventive Services Task Force recommendation of universal screening of adolescent depression should continue. However, given challenges with reading and verbal abilities, screening modifications (reading to them) should be considered.
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Affiliation(s)
- Maria Valicenti-McDermott
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Erin Rivelis
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Carla Bernstein
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Marie Joanne Cardin
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Rosa Seijo
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
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A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021; 10:295-318. [PMID: 34603935 PMCID: PMC8475841 DOI: 10.1007/s40489-021-00293-4] [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] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 10/26/2022]
Abstract
Background The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well. Methods Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist. Results Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies. Discussion Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-021-00293-4.
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Meermeier A, Jording M, Alayoubi Y, Vogel DHV, Vogeley K, Tepest R. Brief Report: Preferred Processing of Social Stimuli in Autism: A Perception Task. J Autism Dev Disord 2021; 52:3286-3293. [PMID: 34532839 PMCID: PMC9213359 DOI: 10.1007/s10803-021-05195-2] [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] [Accepted: 07/08/2021] [Indexed: 11/05/2022]
Abstract
In this study we investigate whether persons with autism spectrum disorder (ASD) perceive social images differently than control participants (CON) in a graded perception task in which stimuli emerged from noise before dissipating into noise again. We presented either social stimuli (humans) or non-social stimuli (objects or animals). ASD were slower to recognize images during their emergence, but as fast as CON when indicating the dissipation of the image irrespective of its content. Social stimuli were recognized faster and remained discernable longer in both diagnostic groups. Thus, ASD participants show a largely intact preference for the processing of social images. An exploratory analysis of response subsets reveals subtle differences between groups that could be investigated in future studies.
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Affiliation(s)
- A Meermeier
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany.
| | - M Jording
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany.,Forschungszentrum Jülich, INM3, NRW, Wilhelm-Johnen-Straße 1, 52428, Jülich, Germany
| | - Y Alayoubi
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany
| | - David H V Vogel
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany.,Forschungszentrum Jülich, INM3, NRW, Wilhelm-Johnen-Straße 1, 52428, Jülich, Germany
| | - K Vogeley
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany.,Forschungszentrum Jülich, INM3, NRW, Wilhelm-Johnen-Straße 1, 52428, Jülich, Germany
| | - R Tepest
- University Hospital Cologne, NRW, Kerpener Strasse 62, Geb. 31, 50931, Cologne, Germany
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Harvery M, Froude EH, Foley KR, Trollor JN, Arnold SRC. Employment profiles of autistic adults in Australia. Autism Res 2021; 14:2061-2077. [PMID: 34374491 DOI: 10.1002/aur.2588] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022]
Abstract
Autistic adults experience a high number of job changes, reduced working hours, minimal workplace supports, and overrepresentation in entry-level and low paid positions. This study adds to the existing evidence base to guide clinical decisions and interventions for this population. This study utilized baseline data collected between 2015 and 2017 from the Autism CRC's Australian Longitudinal Study of Autism in Adulthood. The aim was to describe the employment profiles and explore factors related to employment for Australian autistic adults aged 25 and older (N = 149). Comparisons between participants and the Australian workforce were made using Australian Bureau of Statistics (ABS) data. Two logistic regression models were conducted to explore the association between underemployment and underutilisation with personal and environmental factors. In comparison to the Australian workforce, autistic adults were more likely to work part-time, work reduced hours and be employed at skill levels lower than their qualifications warranted. Logistic regressions reported that more autistic traits, more social supports and having workplace adjustments implemented were significantly associated with a higher odds of autistic adults being appropriately employed and/or utilized in the workforce. Results suggest that interventions implementing appropriate workplace adjustments, a supportive workplace environment, and adequate social supports may improve employment outcomes for autistic adults. All employees may benefit from workplace resources targeted toward fostering an inclusive workplace environment. LAY SUMMARY: This study aimed to describe the employment profiles and explore factors related to employment for Australian autistic adults. We compared this with the Australian workforce using data from the Australian Bureau of Statistics. Autistic adults with more autistic traits and more social and workplace supports were more likely to be employed and have jobs that were better suited to them. Autistic adults might have better employment outcomes if they have the appropriate workplace adjustments, a supportive workplace and adequate social supports.
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Affiliation(s)
- Madeleine Harvery
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Elspeth H Froude
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Kitty-Rose Foley
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, New South Wales, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.,Faculty of Health, Southern Cross University, Brisbane, Queensland, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, New South Wales, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Samuel R C Arnold
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, New South Wales, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
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Greene RK, Vasile I, Bradbury KR, Olsen A, Duvall SW. Autism Diagnostic Observation Schedule (ADOS-2) elevations in a clinical sample of children and adolescents who do not have autism: Phenotypic profiles of false positives. Clin Neuropsychol 2021; 36:943-959. [PMID: 34294006 DOI: 10.1080/13854046.2021.1942220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE While the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) shows high sensitivity for detecting autism spectrum disorder (ASD) when present (i.e. true positives), scores on the ADOS-2 may be falsely elevated for individuals with cognitive impairments or psychological concerns other than ASD (i.e. false positives). This study examined whether demographic, psychological, cognitive, and/or adaptive factors predict ADOS-2 false positives and which psychiatric diagnoses most often result in false positives. METHOD Sensitivity, specificity, false positive, and false negative rates were calculated among 214 5- to 16-year-old patients who completed an ADOS-2 (module 3) as part of an ASD diagnostic evaluation. Additional analyses were conducted with the 101 patients who received clinically elevated ADOS-2 scores (i.e. 56 true positives and 45 false positives). RESULTS Results revealed a 34% false positive rate and a 1% false negative rate. False positives were slightly more likely to be male, have lower restricted and repetitive behavior (RRB) severity scores on the ADOS-2, and demonstrate elevated anxiety during the ADOS-2. Neither IQ, adaptive functioning, nor caregiver-reported emotional functioning was predictive of false positive status. Trauma-related psychiatric diagnoses were more common among false positives. CONCLUSIONS The ADOS-2 should not be used in isolation to assess for ASD, and, in psychiatrically-complex cases, RRB symptom severity may be particularly helpful in differentiating ASD from other psychiatric conditions. Additionally, heightened levels of anxiety, more so than overactivity or disruptive behavior, may lead to non-ASD specific elevations in ADOS-2 scores.
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Affiliation(s)
- Rachel K Greene
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Iulia Vasile
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Kathryn R Bradbury
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Aarika Olsen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Susanne W Duvall
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
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41
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Cassidy SA, Bradley L, Cogger-Ward H, Rodgers J. Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults. Mol Autism 2021; 12:46. [PMID: 34154642 PMCID: PMC8218414 DOI: 10.1186/s13229-021-00449-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups. METHODS A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults, to create the Suicidal Behaviours Questionnaire-Autism Spectrum Conditions (SBQ-ASC). The adapted tool was refined through nine interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups. RESULTS There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test-retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales. LIMITATIONS The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which limits the generalisability of results to the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm. The SBQ-ASC has been designed with and for autistic and possibly autistic adults, and is not appropriate to compare to non-autistic adults given measurement differences between these groups. CONCLUSIONS The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.
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Affiliation(s)
- Sarah A Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Louise Bradley
- The International Centre, University of Bedfordshire, Luton, UK
| | - Heather Cogger-Ward
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- School of Psychology, University of Lincoln, Lincoln, UK
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.
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Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
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43
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Pandey R, Tiwari GK, Rai PK. Restoring and preserving capacity of self-affirmation for well-being in Indian adults with non-clinical depressive tendencies. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2021; 9:135-147. [PMID: 38013799 PMCID: PMC10658854 DOI: 10.5114/cipp.2021.105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Although self-affirmation has been reported to enhance well-being and other positive life outcomes in normal adults, little is known about its capacity to restore and preserve well-being in adults with depressive tendencies. The current study attempts to expound the restoring and preserving capacity of self-affirmation for well-being in Indian adults with non-clinical depressive tendencies. PARTICIPANTS AND PROCEDURE The study used a sequential research design. Eighty participants (22-27 years) with depressive tendencies were chosen through purposive sampling and were randomly assigned equally to the experimental and control conditions. Their depressive tendencies and well-being were measured through standard scales at three intervals: pre-intervention, post-intervention and follow-up. RESULTS The results revealed significant restoring and preserving capacity of self-affirmation for the well-being of the experimental group participants as compared to the control group. The main effects of conditions (experimental, control) and treatment intervals (pre, post, follow-up) were significant along with the interaction effects of conditions × treatment intervals. The significant differences in the mean well-being scores for pre-intervention, post-intervention and follow-up points of time showed the restoring and preserving capacity of self-affirmation intervention. CONCLUSIONS The findings showed that self-affirmation helps to restore well-being as well as preserve it after a significant gap, which is evident in higher well-being mean scores of the experimental group taken at post-intervention and follow-up intervals. The positive effects of self-affirmation on well-being may have remained active even after the cessation of the intervention due to the underlying mechanisms of enhanced self-worth, positive values, inner strengths, positive attributions and interpersonal relationships.
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Affiliation(s)
- Ruchi Pandey
- Department of Psychology, School of Humanities and Social Sciences, Dr. Harisingh Gour University, Sagar, Madhya Pradesh, India
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44
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Dow D, Morgan L, Hooker JL, Michaels MS, Joiner TE, Woods J, Wetherby AM. Anxiety, Depression, and the Interpersonal Theory of Suicide in a Community Sample of Adults with Autism Spectrum Disorder. Arch Suicide Res 2021; 25:297-314. [PMID: 31656121 DOI: 10.1080/13811118.2019.1678537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The present study examines occurrence of depression, anxiety, and suicidality in adults with autism spectrum disorder (ASD), relationships between social difficulties and mental health, and application of the Interpersonal Theory of Suicide in this population. Ninety-eight adults with ASD completed an online survey. Data were analyzed using bivariate correlations, independent samples t-tests, and simple mediational analyses. A substantial proportion reported a lifetime history of anxiety (63%), depression (55%), and suicide attempts (19%), as well as recent suicidal ideation (12%). Social difficulty was associated with higher psychiatric concerns. Thwarted belongingness and perceived burdensomeness were associated with social dissatisfaction, current suicidal ideation, and history of depression. Results suggest the need for widespread screening and intervention services for co-occurring psychiatric conditions in this population.
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45
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Rumball F, Antal K, Happé F, Grey N. Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103836. [PMID: 33453693 DOI: 10.1016/j.ridd.2020.103836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/24/2020] [Accepted: 12/12/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mental health problems are common amongst adults with an Autism Spectrum Disorder (ASD). Stressful and traumatic life events can trigger or exacerbate symptoms of anxiety, depression and PTSD. In the general population, transdiagnostic processes such as suppression and perseverative thinking are associated with responses to trauma and mental health symptoms. AIMS This study explored the relationships between thought suppression, perseverative thinking and symptoms of depression, anxiety and PTSD in ASD adults who reported exposure to a range of DSM-5 and non-DSM-5 traumatic events. METHODS 59 ASD adults completed a series of online self-report questionnaires measuring trauma, transdiagnostic cognitive processes, and mental health symptoms. RESULTS Probable PTSD rarely occurred in isolation and was associated with depression and anxiety symptoms in trauma-exposed ASD adults. All cognitive processes and mental health symptoms were positively associated with one another, regardless of whether the trauma met DSM-5 PTSD Criterion A. When accounting for both cognitive processes, only thought suppression significantly predicted PTSD and anxiety symptoms, while only perseverative thinking significantly predicted depression symptoms. CONCLUSIONS AND IMPLICATIONS These preliminary results suggest that different cognitive processes more strongly affect anxiety/PTSD versus depression symptom severity in trauma-exposed ASD adults, although co-occurring symptoms are common. Implications for assessment, treatment and future research are discussed.
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Affiliation(s)
- Freya Rumball
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
| | - Kinga Antal
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom
| | - Francesca Happé
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom
| | - Nick Grey
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom
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46
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Schiltz HK, Magnus BE. Differential Item Functioning Based on Autism Features, IQ, and Age on the Screen for Child Anxiety Related Disorders (SCARED) Among Youth on the Autism Spectrum. Autism Res 2021; 14:1220-1236. [PMID: 33543824 DOI: 10.1002/aur.2481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 12/28/2022]
Abstract
Anxiety commonly occurs among youth on the autism spectrum, yet measurement of anxiety in this population is complicated by a number of factors, including potentially overlapping symptomatology, the child's intellectual functioning, and changes in anxiety across development. Moreover, few studies have examined the psychometric properties of anxiety measures in this population, and no study to date has tested whether there are systematic differences in the measurement of anxiety, or differential item functioning (DIF), across the high degree of heterogeneity and the developmental course of autism. To test this possibility, data were combined across multiple studies using the National Database for Autism Research, an NIH-funded data repository. Parent-report on the Screen for Child Anxiety Related Disorders (SCARED) and Social Communication Questionnaire (SCQ) were used as measures of anxiety and autism features, respectively. A confirmatory factor analysis indicated good fit of the literature standard five-factor structure. Moderated nonlinear factor analysis (MNLFA) revealed multiple items with intercept and loading DIF based on level of autism features, IQ, and age, especially for items related to social behavior. Therefore, although the measure's factor structure is consistent with that found in the general population, the SCARED may not capture differences in anxiety equivalently for all children on the spectrum and across their development. Clinicians and researchers need to be especially vigilant in measuring anxiety symptoms in children with autism by removing items flagged for DIF from the SCARED and/or by using multiple measures and informants. LAY ABSTRACT: Autistic youth often experience clinical levels of anxiety. Many tools used to measure anxiety were developed for the general population, but not for use with autistic youth. This study found that the Screen for Child Anxiety Related Disorders (SCARED) measures the same five dimensions of anxiety as in the general population. Parents, however, may respond differently to questions on the SCARED based on their child's autism features, intellectual functioning, and age, which impacts our ability to accurately measure anxiety among autistic youth.
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Affiliation(s)
- Hillary K Schiltz
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Brooke E Magnus
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts, USA
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Stephenson KG, Beck JS, South M, Norris M, Butter E. Validity of the WISC-V in Youth with Autism Spectrum Disorder: Factor Structure and Measurement Invariance. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:669-681. [PMID: 33448884 DOI: 10.1080/15374416.2020.1846543] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Assessment of intellectual abilities in individuals with autism spectrum disorder (ASD) is a core component of a comprehensive diagnostic evaluation. However, relatively limited information is available regarding the validity of one of the most commonly-used measures of intelligence, the Wechsler Intelligence Scale for Children - 5th Edition (WISC-V) in ASD.Method: We investigated the factor structure and measurement invariance of the WISC-V in a sample of 349 children aged 6-16 diagnosed with ASD using single- and multi-group confirmatory factor analysis. The comparison group was the WISC-V standardization sample.Results: A four-index bifactor solution best fit the ASD group data. Measurement invariance analyses indicated support for configural and metric, but not scalar, invariance of the published 5-index structure, suggesting systematic differences in performance among some subscales in ASD. The 7-subtest FSIQ scale had partial scalar invariance after relaxing equality constraints on the Coding and Digit Span subtest intercepts, suggesting sources other than theorized IQ ability contribute to lower scores on these subtests within ASD. The Cognitive Proficiency Index (CPI) failed to demonstrate appropriate fit in baseline models. The General Ability Index (GAI) had full configural, metric, and scalar invariance.Conclusions: Statistical bias on the WISC-V within ASD in processing speed and working memory subtests creates significant limitations for the use of FSIQ and especially CPI index scores in ASD populations. The GAI showed strong measurement properties and should be considered as the preferred indicator of overall intellectual functioning when assessing children with ASD using the WISC-V.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
| | - Jonathan S Beck
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | - Mikle South
- Departments of Psychology and Neuroscience, Brigham Young University
| | - Megan Norris
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
| | - Eric Butter
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
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48
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Suicidality in Adults with Autism Spectrum Disorder: The Role of Depressive Symptomatology, Alexithymia, and Antidepressants. J Autism Dev Disord 2020; 50:3585-3597. [PMID: 32172508 DOI: 10.1007/s10803-020-04433-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
People with autism spectrum disorder (ASD) have an increased risk of suicidality. However, the risk factors remain under-investigated. This study explored factors that increase suicidality risk in ASD. Through an online survey, 150 adults with ASD were compared to 189 control adults. Autistic traits, depressive symptomatology, alexithymia, and antidepressant intake were assessed on their contribution predicting suicidality. Among people with ASD, 63% scored above the cutoff for high suicidality risk. Increased autistic traits, depressive symptomatology, and antidepressant intake significantly predicted suicidality. Furthermore, among those with high levels of autistic traits, the risk of suicidality was increased if they also had high levels of alexithymia. These results highlight the importance of considering depression, antidepressants, and alexithymia to prevent suicidality in ASD.
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49
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Cassidy SA, Gould K, Townsend E, Pelton M, Robertson AE, Rodgers J. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord 2020; 50:3638-3648. [PMID: 31820344 PMCID: PMC7502035 DOI: 10.1007/s10803-019-04323-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.
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Affiliation(s)
- S A Cassidy
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK. .,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - K Gould
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - M Pelton
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - A E Robertson
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - J Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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50
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Abstract
We explored the appropriateness and measurement properties of a suicidality assessment tool (SBQ-R) developed for the general population, in autistic adults—a high risk group for suicide. 188 autistic adults and 183 general population adults completed the tool online, and a sub-sample (n = 15) were interviewed while completing the tool. Multi-group factorial invariance analysis of the online survey data found evidence for metric non-invariance of the SBQ-R, particularly for items three (communication of suicidal intent) and four (likelihood of suicide attempt in the future). Cognitive interviews revealed that autistic adults did not interpret these items as intended by the tool designers. Results suggest autistic adults interpret key questions regarding suicide risk differently to the general population. Future research must adapt tools to better capture suicidality in autistic adults.
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