Clinical characteristics of mild autism in adults

"I'm the Family Ringmaster and Juggler": Autistic Parents' Experiences of Parenting During the COVID-19 Pandemic

Background

Little is known about autistic parenthood. The literature that exists suggests that autistic parents can find it difficult to manage the everyday demands of parenting and domestic life. While emerging research has also highlighted more positive parenting experiences, greater understanding of autistic parenthood is needed.

Objective

This study sought to understand autistic parents' parenting experiences during the initial phase of the COVID-19 pandemic.

Methods

Thirty-five Australian autistic parents (95% women) of autistic children (aged 4-25 years) took part in semi-structured interviews designed to elicit their experiences of life during lockdown. We used reflexive thematic analysis using an inductive (bottom-up) approach to identify patterned meanings within the data set.

Results

Autistic parents repeatedly spoke of how the lockdown brought some initial relief from the intensity of their usual lives caring for their children. Nevertheless, most autistic parents felt that the "cumulative stress" of trying to juggle everything during lockdown proved very challenging, which eventually took its toll on parents' mental health. Parents were aware that they needed support but found it difficult to reach out to their usual social supports (including autistic friends) for help, and formal supports were virtually nonexistent. Consequently, they felt "very much forgotten." Nevertheless, they described how their connections with their children grew stronger over lockdown as they focused on nurturing their children's "mental health ahead of everything else."

Conclusions

Our analysis shows how challenging conventional life can be for autistic parents. Parenting requires grappling with a distinctive set of demands, which are usually partially manageable through the informal supports many autistic parents draw upon. The relative absence of informal supports during the pandemic, however, left them reliant on more formal supports, which were not forthcoming. Research is urgently needed to identify the most effective formal supports for autistic parents, ideally in partnership with autistic parents themselves.

"Peas in a pod": Oral History Reflections on Autistic Identity in Family and Community by Late-Diagnosed Adults

In this paper, we report on a participatory oral history study documenting the lives of late-diagnosed autistic adults in Australia. We interviewed 26 autistic adults about their life history and the impact of late diagnosis. All were diagnosed after the age of 35, growing up in an era when autism was not well known. Using reflexive thematic analysis, we uncovered a rich body of reflections on shared Autistic identity and identified three major themes within that data set: 'conceptualising the Autistic family', 'creating Autistic community', and 'contesting Autistic identity'. Overall, the study provides insights into the active creation of shared Autistic identity and the importance of Autistic community to these late-diagnosed autistic adults.

The Production of Pronouns and Verb Inflections by Italian Children with ASD: A New Dataset in a Null Subject Language

The language of children with autism spectrum disorder (ASD) is often characterized by difficulties with pronouns. The underlying reasons for such difficulties are still unclear. This study is the first to test the abilities of children with ASD who speak Italian, a language in which overt subject pronouns are optional but verbs obligatorily feature person-referencing morphology. We found that Italian children with ASD were less accurate than typically-developing (TD) Italian children in the production of first-, second-, and third-person singular pronouns, avoiding pronouns in favor of nouns or names more often than controls. Moreover, children with ASD produced more overt pronouns than null pronouns in marked contexts, compared to TD children. These phenomena can be accounted for by difficulties with pragmatics.

MMPI-2 Personality Profiles of High-Functioning Adults With Autism Spectrum Disorders

The Minnesota Multiphasic Personality Inventory-Second Edition was administered to 20 adults with autism spectrum disorders (ASD) who fell in the average to above average range of intelligence and 24 age-, intelligence-, and gender-matched college students. Large group differences, with the ASD group scoring higher, were found on the L validity scale, Clinical Scales 2 (D) and 0 (Si), Content scale Social Discomfort (SOD), Supplementary scale Repression (R), and Personality Psychopathology Five (PSY-5) scale INTR (Introversion). The proportion of ASD adults scoring in the clinical range on these scales was between 25% and 35%. High scores on these scales are consistent with the clinical picture of Asperger syndrome and high-functioning autism in adulthood. Future directions and implications for identifying adults in need of a specialized autism assessment are discussed.

Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report

This paper highlights the clinical challenges faced when assessing patients with stalking behaviors with psychotic disorders, suggesting the need for an accurate assessment of adult autism spectrum symptoms. A 25-year-old man with a diagnosis of delusional disorder, erotomanic type, was hospitalized for acute psychotic symptoms occurred in the framework of a repeated stalking behavior towards his ex girlfriend. When assessed for adult autism spectrum symptoms upon an accurate clinical evaluation, he reported elevated scores in the mentalizing deficit and social anxiety domains by means of the 14 item Ritvo Autism and Asperger Diagnostic Scale (RAADS-14). Authors discuss a possible role of adult (subthreshold) autism spectrum symptoms, generally disregarded in adult psychiatry, on the type of psychotic features and stalking behavior developed that may help for appropriate diagnosis and treatment.

The Use of Sign Language Pronouns by Native-Signing Children with Autism

We report the first study on pronoun use by an under-studied research population, children with autism spectrum disorder (ASD) exposed to American Sign Language from birth by their deaf parents. Personal pronouns cause difficulties for hearing children with ASD, who sometimes reverse or avoid them. Unlike speech pronouns, sign pronouns are indexical points to self and other. Despite this transparency, we find evidence from an elicitation task and parental report that signing children with ASD avoid sign pronouns in favor of names. An analysis of spontaneous usage showed that all children demonstrated the ability to point, but only children with better-developed sign language produced pronouns. Differences in language abilities and self-representation may explain these phenomena in sign and speech.

Clinical evidence that Asperger's disorder is a mild form of autism

OBJECTIVE

The aim of this study is to obtain clinical evidence to test the hypothesis that Asperger's disorder (AD) is a mild form of autism (AU).

METHOD

A 78-item Likert scale (the RAADS) was administered to 25 adults with AD and 19 with AU (ages, 18-65 years) to assess presence, type, and duration of symptoms.

RESULTS

The following results were found: (a) subjects with AD and AU have similar symptoms throughout adulthood (responses to 72 of 78 questions were not significantly different); (b) subjects with AD had a significantly fewer total number of symptoms; (c) subjects with AD reported nonsignificantly fewer symptoms in the DSM-IV-TR domains of social interaction and repetitive patterns of behavior; and (d) subjects with AD had significantly fewer symptoms in the communication domain.

CONCLUSIONS

The data support the hypothesis that AD is a mild form of AU, and that they share a common etiology and developmental neuropathology. It appears warranted in future diagnostic manuals to incorporate AU and AD into 1 diagnostic category such as, "Autism Spectrum Disorder, (with modifiers, severe, moderate, mild, atypical, and Asperger's type)."

Diagnoses commonly missed in childhood. Long-term outcome and implications for treatment

Psychiatric and developmental disorders with onset in early childhood are often missed and commonly overlooked by adult psychiatrists. These disorders have important continuities into adulthood and are powerful predictors of chronicity, comorbidity, and severity. It is essential that they are recognized and taken into account in the assessment and treatment of the adult patient.

Guidelines for evaluating intervention programs for children with autism

It is now well recognized that early diagnosis and intervention improves the prognosis for children with autism. It is crucial that professionals be aware and sensitive to the needs of autistic persons and their families. We must never lose sight of the long-term goal of treatment and must not become so infatuated with any one treatment that we fail to provide the education parents need. It is incumbent upon us, as professionals, to educate parents and help them evaluate the myriad of information with which they are bombarded. In this article a framework for thinking about autism and principles of evaluation are reviewed. Components of appropriate early intervention programs are then described and guidelines for evaluating alternative treatments are provided.

Schizophrenia and autism considered as the products of an agnosic right shift gene

Crow (1995a) has argued that schizophrenia is caused by a gene associated with the evolution of human language and cerebral specialisation. This paper suggests a mechanism for Crow's theory which requires only one new assumption for the right shift genetic model of handedness and cerebral dominance (Annett, 1978). The proposal is that the RS+ allele, whose normal function is to induce the left hemisphere to serve speech by impairing speech-related cortex in the right hemisphere, tends to lose its directional coding. It becomes agnosic (RS+ a) for right versus left and impairs the left or right hemisphere at random. Schizophrenia is likely to develop when the RS+ a gene is paired with a normal RS+ gene but only in the 50% of cases where both hemispheres are affected. In the 50% where RS+ a affects the right hemisphere, development is normal as in the RS+ RS+ genotype. The risks for schizophrenia in monozygotic and dizygotic twins and other relatives are as expected for 50% expression of a Mendelian gene which is paired with a particular allele, but not alternative alleles at the same locus. The frequency of homozygotes for the agnosic gene is about 4 in 10,000, the rate observed for autism. A random pattern of double hemisphere deficits would give scope for a range of developmental strengths and weaknesses as observed within the spectrum of autistic disorders. Tests of the model require brain-imaging studies sensitive to individual differences in hemisphere lateralisation and a search for a genetic locus with human and nonhuman primate alleles, together with a mutant of the human form with a frequency of about 2%.