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Woodhouse E, Hollingdale J, Davies L, Al-Attar Z, Young S, Vinter LP, Agyemang K, Bartlett C, Berryessa C, Chaplin E, Deeley Q, Freckelton I, Gerry F, Gudjonsson G, Maras K, Mattison M, McCarthy J, Mills R, Misch P, Murphy D, Allely C. Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience. BMC Med 2024; 22:157. [PMID: 38609939 PMCID: PMC11015650 DOI: 10.1186/s12916-024-03320-3] [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: 06/25/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION Greater attention needs to be given to this population as they navigate the CJS.
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Affiliation(s)
- Emma Woodhouse
- Compass Psychology Services Ltd, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Zainab Al-Attar
- University of Oxford, London, UK
- University College London, London, UK
- Victoria University, Melbourne, Australia
- University of Central Lancashire, Preston, UK
| | - Susan Young
- Psychology Services Limited, London, UK
- University of Reykjavík, Reykjavík, Iceland
| | - Luke P Vinter
- Department of Criminology, University of Derby, Derby, UK
| | | | | | | | - Eddie Chaplin
- London South Bank University, Institute of Health and Social Care, London, UK
| | - Quinton Deeley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Autism Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Freckelton
- Law Faculty and Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Castan Chambers, Melbourne, Australia
| | - Felicity Gerry
- Libertas Chambers, London, UK
- Crockett Chambers, Melbourne, Australia
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Auckland, Auckland, New Zealand
| | - Richard Mills
- AT-Autism, London, UK
- Department of Psychology, University of Bath, Bath, UK
| | | | - David Murphy
- Broadmoor Hospital, West London NHS Trust, London, UK
| | - Clare Allely
- School of Health and Society, University of Salford, Manchester, UK.
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Huntjens A, van den Bosch LMCW, Sizoo B, Kerkhof A, Smit F, van der Gaag M. The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial. Psychol Med 2024:1-12. [PMID: 38606582 DOI: 10.1017/s0033291724000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUNDS Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts. METHODS At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes. RESULTS At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition. CONCLUSIONS DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | - Ad Kerkhof
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
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O'Connor RA, Doherty M, Ryan-Enright T, Gaynor K. Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:816-830. [PMID: 38145308 DOI: 10.1177/13623613231215026] [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: 12/26/2023]
Abstract
LAY ABSTRACT Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.
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Affiliation(s)
- Rachel Ag O'Connor
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Mary Doherty
- Brighton and Sussex Medical School, Brighton, UK
- Our Lady's Hospital, Navan, Republic of Ireland
| | - Theresa Ryan-Enright
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Republic of Ireland
- DETECT, Early Intervention Service, Blackrock, Republic of Ireland
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Huntjens A, Landlust A, Wissenburg S, van der Gaag M. The Prevalence of Suicidal Behavior in Autism Spectrum Disorder. CRISIS 2024; 45:144-153. [PMID: 37668055 DOI: 10.1027/0227-5910/a000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background: Suicidal ideation (SI) and suicide attempts (SA) are common in autistic individuals, but prevalence rates have not yet been estimated with meta-analysis. Aims: This meta-analysis aims to estimate SI and SA prevalence rates in autistic individuals and identify subgroup differences based on sample characteristics and study quality. Methods: A systematic search identified 52 studies with 88,509 autistic participants reporting SI and SA. Pooled prevalence estimates were calculated using a random-effects model. Results: Pooled prevalence estimates of lifetime SI and SA were 37.2% [95% CI 25.3-50.8] and 15.3% [95% CI 9.5-23.6], respectively. For 12-month prevalence, this was 25.4% [95% CI 19.0-33.2] and 14.1% [95% CI 7.4-25.2], respectively. Subgroup analyses revealed significant differences based on age (SI), region (SI), data collection (SI), measurement scales used to define autism and suicidality (SA), and representation of the study sample (SI and SA). Heterogeneity measures were high for all outcomes (I2 = 60.3-99.1%). Limitations: The heterogeneity of the included studies may limit the generalizability of our findings. Conclusion: The high rates of suicidal problems in autistic individuals call for a systematic evaluation of suicidality in clinical practice and adequate therapeutic interventions to improve this condition.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - Annemiek Landlust
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, The Netherlands
| | - Sophie Wissenburg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
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Cook ML, Tomaszewski B, Lamarche E, Bowman K, Klein CB, Stahl S, Klinger LG. Suicide risk in transition-aged autistic youth: The link among executive function, depression, and autistic traits. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241227983. [PMID: 38340034 DOI: 10.1177/13623613241227983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
LAY ABSTRACT Autistic people are more likely to consider suicide than non-autistic people, with transition-aged youth (ages 16-21 years) at potentially the highest risk. Research has also shown that difficulties with executive functioning (e.g., difficulties with organization, sequencing, and decision-making) may heighten suicide risk among non-autistic people, but it is not clear whether this is also true for autistic people. This study explored this question by asking 183 transition-aged autistic youth about their experience with suicidal behavior and examining the relationship between their responses and additional measures of depression, autistic traits, and executive function skills. About one-third of autistic transition-aged youth (33.3%) said that they had experienced thoughts of hurting themselves with the intent to end their lives (i.e., suicidal ideation). Both depression and executive function challenges predicted suicide risk (i.e., participants who experienced depression were more likely to have had suicidal thoughts than those who had not, and participants who had more difficulty with executive function skills were more likely to have had suicidal thoughts than those who had less difficulty). These findings suggest that executive functioning, a common area of difficulty among autistic people, is an important indicator of suicide risk in this population.
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Affiliation(s)
- Michal L Cook
- The University of North Carolina at Chapel Hill, USA
| | | | | | | | | | - Sara Stahl
- The University of North Carolina at Chapel Hill, USA
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Kitamura S, Matsuoka K, Takahashi M, Yoshikawa H, Minami A, Ohnishi H, Ishida R, Miyasaka T, Tai Y, Ochi T, Tanaka T, Makinodan M. Association of adverse childhood experiences and cortical neurite density alterations with posttraumatic stress disorder symptoms in autism spectrum disorder. Front Psychiatry 2023; 14:1215429. [PMID: 37743992 PMCID: PMC10515392 DOI: 10.3389/fpsyt.2023.1215429] [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: 05/01/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) can be a source of significant social and daily distress in autism spectrum disorder (ASD). Compared to typically developed (TD) individuals, people with ASD are at an increased risk of adverse childhood experiences (ACEs), which can result in abnormal neuronal development. However, whether or how ACEs influence abnormal neural development and PTSD symptoms in ASD has not been fully elucidated. Methods Thirty-nine TD individuals and 41 individuals with ASD underwent T1-weighted magnetic resonance imaging and neurite orientation dispersion and density imaging (NODDI), with axonal and dendritic densities assessed in terms of the orientation dispersion index and neurite density index (NDI), respectively. Voxel-based analyses were performed to explore the brain regions associated with PTSD symptoms, and the relationships between the severity of ACEs and PTSD symptoms and NODDI parameters in the extracted brain regions were examined. Results There was a significant positive association between PTSD symptom severity and NDI in the bilateral supplementary motor area; right superior frontal, left supramarginal, and right superior temporal gyrus; and right precuneus in the ASD group, but not in the TD group. ACE severity was significantly associated with NDI in the right superior frontal and left supramarginal gyrus and right precuneus in the ASD group. Moreover, NDI in the right precuneus mainly predicted the severity of PTSD symptoms in the ASD group, but not the TD group. Conclusion These results suggest that ACE-associated higher neurite density is of clinical importance in the pathophysiology of PTSD symptoms in ASD.
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Affiliation(s)
- Soichiro Kitamura
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Functional Brain Imaging Research, National Institute Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Functional Brain Imaging Research, National Institute Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroaki Yoshikawa
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Akihiro Minami
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroki Ohnishi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Rio Ishida
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshiteru Miyasaka
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Japan
| | - Yumi Tai
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoko Ochi
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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Nyrenius J, Waern M, Eberhard J, Ghaziuddin M, Gillberg C, Billstedt E. Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury. BJPsych Open 2023; 9:e167. [PMID: 37674410 PMCID: PMC10594204 DOI: 10.1192/bjo.2023.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. AIMS We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. METHOD Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. RESULTS In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. CONCLUSIONS Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.
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Affiliation(s)
- Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | - Margda Waern
- Sahlgrenska Suicide Studies, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jonas Eberhard
- Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | | | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
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White SW, Siegle GJ, Kana R, Rothman EF. Pathways to Psychopathology Among Autistic Adults. Curr Psychiatry Rep 2023; 25:315-325. [PMID: 37378790 PMCID: PMC11078254 DOI: 10.1007/s11920-023-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels. RECENT FINDINGS We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems. Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.
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Affiliation(s)
- Susan W White
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Greg J Siegle
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rajesh Kana
- Center for Innovative Research in Autism, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Emily F Rothman
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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9
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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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Kallitsounaki A, Williams DM. Brief Report: An Exploration of Alexithymia in Autistic and Nonautistic Transgender Adults. AUTISM IN ADULTHOOD 2023; 5:210-216. [PMID: 37346987 PMCID: PMC10280221 DOI: 10.1089/aut.2022.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background Research has shown that many autistic people have alexithymia, a psychological trait characterized by difficulties in identifying and describing emotions. It is also now clear that there is a high rate of autism among transgender people, but we know little about the intersection of autism and gender diversity or about the clinical features of autistic transgender individuals. Methods Seventy-eight nonautistic transgender, 56 autistic transgender, 106 nonautistic cisgender, and 107 autistic cisgender adults completed the Toronto Alexithymia Scale-20 and the Autism-spectrum Quotient as part of an online study. We also used the General Alexithymia Factor Score-8 as an additional alexithymia score. Results We found that nonautistic transgender participants reported significantly higher mean levels of alexithymia than nonautistic cisgender participants, and that there was a significant overrepresentation of individuals in this group who met the clinical cutoff for alexithymia. The difference in alexithymia between autistic cisgender and autistic transgender participants was nonsignificant, with >50% of each group scoring above the clinical cutoff point. Of note, when we used the General Alexithymia Factor Score-8, the difference between autistic transgender participants and autistic cisgender participants was significant, with autistic transgender participants reporting higher mean levels of alexithymia. Conclusion Results suggest that nonautistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than nonautistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among nonautistic transgender people and potentially higher than among autistic cisgender people. Our findings are in keeping with evidence of a subgroup of transgender people with "subclinical autism" and inconsistent with the notion that autism among transgender and gender diverse people is a "phenomimic" of autism. Lastly, our study highlights the potential importance of screening autistic and nonautistic transgender people for alexithymia.
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Affiliation(s)
| | - David M. Williams
- School of Psychology, University of Kent, Canterbury, United Kingdom
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11
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Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S. A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Mol Autism 2023; 14:12. [PMID: 36922899 PMCID: PMC10018918 DOI: 10.1186/s13229-023-00544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. AIMS To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. RESULTS Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. CONCLUSIONS The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lucy Phillips
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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12
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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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13
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Cleary M, West S, McLean L, Kornhaber R, Hungerford C. Two Halves of the Same Whole: A Framework to Integrate Autism and Mental Health Services. Issues Ment Health Nurs 2023; 44:93-103. [PMID: 36206026 DOI: 10.1080/01612840.2022.2126570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Given the higher rates of co-occurring mental health issues experienced by autistic people, there is a pressing need to implement an effective framework that integrates autism services with appropriate mental health services. This paper discusses the impact of mental illness on the person with autism and their families, and the current challenges they face when accessing mental health support. A framework for service providers is proposed to support the mental health needs and preferences of autistic people. The paper concludes by highlighting the importance of health professionals utilising mental health interventions appropriate for autistic people, including autism-specific suicide prevention and awareness programs.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Campus, WSLHD, North Parramatta, New South Wales Australia
| | - Rachel Kornhaber
- College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia.,Faculty of Health, Federation University, Melbourne, Victoria, Australia
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14
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Cervantes PE, Brown DS, Horwitz SM. Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:226-243. [PMID: 35608134 PMCID: PMC9684352 DOI: 10.1177/13623613221091316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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15
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Thapar A, Livingston LA, Eyre O, Riglin L. Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression. J Child Psychol Psychiatry 2023; 64:4-15. [PMID: 35972029 PMCID: PMC10087979 DOI: 10.1111/jcpp.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.
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Affiliation(s)
- Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy A Livingston
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olga Eyre
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
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16
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Mahony C, O'Ryan C. A molecular framework for autistic experiences: Mitochondrial allostatic load as a mediator between autism and psychopathology. Front Psychiatry 2022; 13:985713. [PMID: 36506457 PMCID: PMC9732262 DOI: 10.3389/fpsyt.2022.985713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Molecular autism research is evolving toward a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and toward alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and wellbeing of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.
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Affiliation(s)
| | - Colleen O'Ryan
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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17
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Moseley RL, Gregory NJ, Smith P, Allison C, Cassidy S, Baron-Cohen S. Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample. Mol Autism 2022; 13:45. [PMID: 36371252 PMCID: PMC9655904 DOI: 10.1186/s13229-022-00522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults. METHODS Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI. RESULTS While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability. LIMITATIONS Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community. CONCLUSIONS Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.
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Affiliation(s)
- Rachel L. Moseley
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Nicola J. Gregory
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Paula Smith
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Simon Baron-Cohen
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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18
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Normansell-Mossa KM, Top DN, Russell N, Freeston M, Rodgers J, South M. Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults. Front Psychol 2021; 12:731753. [PMID: 34867612 PMCID: PMC8635111 DOI: 10.3389/fpsyg.2021.731753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
Several models of anxiety in autistic adults have focused on the role of intolerance of uncertainty which has biological and evolutionary bases, as a cognitive explanation for the high prevalence of anxiety in autism. This framework suggests that all people are born with a healthy level of intolerance of uncertainty, and as we develop, this intolerance is lessened as we learn when situations are safe and begin to understand and manage the uncertainty. This process of learning about managing uncertainty does not happen in the same way in those who are high in autistic traits, which could be the reason for the high levels of anxiety symptoms commonly seen in this population. We examined archival data of 199 non-autistic and 55 autistic adults from prior studies in which we collected self-report measures of autistic traits, intolerance of uncertainty, sensory processing, and anxiety. We conducted two path analyses to examine the role of intolerance of uncertainty in anxiety in autistic adults. The first model tested the idea that intolerance of uncertainty, an evolutionary phenomenon common for all people, could explain some of the cognitive aspects of anxiety in autism. The second model suggests that primary neurodevelopmental differences associated with autistic traits underlie the sensory sensitivity and sensory seeking behaviors, which in turn increase intolerance of uncertainty and subsequent anxiety. We found that the “neurodevelopmental” model had better model fit than the “evolutionary stress” model, suggesting that the neurodevelopmental impact of higher levels of autistic traits could moderate a non-autistic trajectory of learning to manage uncertainty as children develop and understand that uncertainty is common and acceptable.
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Affiliation(s)
| | - D Nicholas Top
- Student Health Services, Utah Valley University, Orem, UT, United States
| | - Nicholas Russell
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle upon Tyne, United Kingdom
| | - Mikle South
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University, Provo, UT, United States
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19
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Abstract
PURPOSE The purpose of this study was to explore the experiences of autistic women who breastfed. STUDY DESIGN AND METHODS We used a qualitative phenomenology design and a thematic analysis method. Semistructured interviews were conducted using a purposive sample from social media support groups for autistic adults. The interview involved one overarching question about their breastfeeding experience. RESULTS Twenty-three autistic women who breastfed their infant(s) participated in our study. Three main themes were identified including intense sensory perception, focused determination, and one size doesn't fit all. Three subthemes helped to describe intense sensory perception: overstimulated, overtouched, and overwhelmed. CLINICAL IMPLICATIONS Autistic adults can have social interaction and expressive communication differences. Nurses can promote positive communication and provide appropriate care through supportive action. These findings offer a guide for nurses to better understand the experiences of autistic breastfeeding women.
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20
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Precision Autism: Genomic Stratification of Disorders Making Up the Broad Spectrum May Demystify Its "Epidemic Rates". J Pers Med 2021; 11:jpm11111119. [PMID: 34834471 PMCID: PMC8620644 DOI: 10.3390/jpm11111119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decade, Autism has broadened and often shifted its diagnostics criteria, allowing several neuropsychiatric and neurological disorders of known etiology. This has resulted in a highly heterogeneous spectrum with apparent exponential rates in prevalence. I ask if it is possible to leverage existing genetic information about those disorders making up Autism today and use it to stratify this spectrum. To that end, I combine genes linked to Autism in the SFARI database and genomic information from the DisGeNET portal on 25 diseases, inclusive of non-neurological ones. I use the GTEx data on genes’ expression on 54 human tissues and ask if there are overlapping genes across those associated to these diseases and those from SFARI-Autism. I find a compact set of genes across all brain-disorders which express highly in tissues fundamental for somatic-sensory-motor function, self-regulation, memory, and cognition. Then, I offer a new stratification that provides a distance-based orderly clustering into possible Autism subtypes, amenable to design personalized targeted therapies within the framework of Precision Medicine. I conclude that viewing Autism through this physiological (Precision) lens, rather than viewing it exclusively from a psychological behavioral construct, may make it a more manageable condition and dispel the Autism epidemic myth.
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21
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Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study. J Autism Dev Disord 2021; 52:4337-4354. [PMID: 34626285 PMCID: PMC8501315 DOI: 10.1007/s10803-021-05317-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID). Emotion dysregulation (ED), the difficulty in modulating emotions, has been identified as an important risk factor. Dialectical behavior therapy (DBT) has been proved effective to treat ED in disorders other than autism spectrum disorder. Our study aimed at assessing the feasibility, acceptability and preliminary efficacy of DBT in seven autistic adults without ID exhibiting self-harm and/or suicidal behaviors linked to severe ED. Our results suggest that DBT is feasible and highly acceptable to autistic adults without ID. Additionally, mean scores on the Difficulties in Emotion Regulation Scale decreased significantly post-treatment and at 4-month follow-up, suggesting that DBT might be efficacious in reducing ED in this population.
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22
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Williams ZJ, Gotham KO. Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory. Mol Autism 2021; 12:56. [PMID: 34376227 PMCID: PMC8353782 DOI: 10.1186/s13229-021-00463-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/31/2021] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. METHODS This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. RESULTS The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. LIMITATIONS Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. CONCLUSIONS These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN 37232 USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN USA
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23
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Kitamura S, Makinodan M, Matsuoka K, Takahashi M, Yoshikawa H, Ishida R, Kishimoto N, Yasuno F, Yasuda Y, Hashimoto R, Miyasaka T, Kichikawa K, Kishimoto T. Association of adverse childhood experiences and precuneus volume with intrusive reexperiencing in autism spectrum disorder. Autism Res 2021; 14:1886-1895. [PMID: 34185397 DOI: 10.1002/aur.2558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/07/2022]
Abstract
Compared to typically developing (TD) children, people with autism spectrum disorder (ASD) have an increased risk of adverse childhood experiences (ACEs). Exposure to ACEs is associated with adult ASD psychological comorbidities, such as posttraumatic stress disorder (PTSD). Occurrence of intrusive event reexperiencing, characteristic of PTSD, often causes social dysfunction in adults with ASD, but its pathological basis is unclear. This study examined brain regions related to the severity of intrusive reexperiencing and explored whether ACE severity was associated with that of intrusive reexperiencing and/or extracted regional gray matter volume. Forty-six individuals with ASD and 41 TD subjects underwent T1-weighted magnetic resonance imaging and evaluation of ACEs and intrusive reexperiencing. Brain regions related to the severity of intrusive reexperiencing in both groups were identified by voxel-based whole brain analyses. Associations among the severity of intrusive reexperiencing, that of ACEs, and gray matter volume were examined in both groups. The severities of intrusive reexperiencing and ACEs were significantly associated with reduced gray matter volume in the right precuneus in individuals with ASD but not in TD subjects. Although the right precuneus gray matter volume was smaller in individuals with ASD and severe ACEs than in those with mild ACEs or TD subjects, it was similar in the latter two groups. However, ACE-dependent gray matter volume reduction in the right precuneus led to intrusive reexperiencing in individuals with ASD. This suggests that exposure to ACEs is associated with right precuneus gray matter reduction, which is critical for intrusive reexperiencing in adults with ASD. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) are at increased risk of adverse childhood experiences (ACEs) and of subsequent manifestation of intrusive reexperiencing of stressful life events. The present study found that reduced gray matter volume in the right precuneus of the brain was associated with more severe intrusive reexperiencing of ACEs by individuals with ASD. These results suggest that ACEs affect neural development in the precuneus, which is the pathological basis of intrusive event reexperiencing in ASD.
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Affiliation(s)
- Soichiro Kitamura
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroaki Yoshikawa
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Rio Ishida
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Department of Psychiatry, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka, University, Osaka, Japan.,Medical Corporation Foster, Osaka, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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24
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Williams ZJ, Gotham KO. Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale. Mol Autism 2021; 12:20. [PMID: 33653400 PMCID: PMC7971146 DOI: 10.1186/s13229-021-00427-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. METHODS We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample. RESULTS The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism. LIMITATIONS Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations. CONCLUSIONS These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN 37232 USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN USA
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Affiliation(s)
- Mikle South
- Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah
| | - Andreia P Costa
- Department of Behavioural and Cognitive Sciences, Université du Luxembourg, Luxembourg City, Luxembourg
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
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Cassidy SA, Robertson A, Townsend E, O'Connor RC, Rodgers J. Advancing Our Understanding of Self-harm, Suicidal Thoughts and Behaviours in Autism. J Autism Dev Disord 2020; 50:3445-3449. [PMID: 32880789 DOI: 10.1007/s10803-020-04643-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah A Cassidy
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Ashley Robertson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.,School of Psychology, University of Glasgow, Glasgow, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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