ASSERT--the Autism Symptom SElf-ReporT for adolescents and adults: bifactor analysis and validation in a large adolescent population

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol)

Background

Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk.

Aim

To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK.

Method

Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024.

Outcome

The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT).

Impact

Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome.

Clinical Trial Registration

ClinicalTrial.gov, identifier NCT05023447.

Cognitive functioning in adult psychiatric patients with and without attention-deficit/hyperactivity disorder

INTRODUCTION

Studies of cognitive functioning in patients with attention-deficit/hyperactivity disorder (ADHD) have often used healthy comparison groups. The present study examines cognitive profiles, including general intellectual and executive functions, in a young adult psychiatric outpatient clientele with ADHD and evaluates whether their cognitive profiles can help differentiate them from patients with non-ADHD-associated psychiatric disorders.

METHODS

The study group comprised 141 young adult psychiatric patients (age range 18-25 years) of whom 78 had ADHD. Comprehensive neuropsychological assessment included the Wechsler Adult Intelligence Scale, 4th version and subtests from Delis-Kaplan Executive Function System. Clinical psychiatric assessments and diagnostic evaluation were performed.

RESULTS

The ADHD group (including all subtypes) had significantly lower verbal comprehension and full-scale intelligence quotient than the non-ADHD group. Tests measuring working memory or executive function did not separate those with and without ADHD.

CONCLUSION

The results of our study suggest that, except for the need to establish overall cognitive performance level, the clinical implication of testing is small if the purpose is to "rule out" an ADHD diagnosis.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

INTRODUCTION

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need.

METHODS AND ANALYSES

In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD.

ETHICS AND DISSEMINATION

This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation

OBJECTIVE

Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood.

METHODS

Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed.

RESULTS

At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women.

CONCLUSION

Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.

Should We Continue to Tell Autistic People that Their Brains are Different?

Autism is often considered to reflect categorically 'different brains'. Neuropsychological research on autism spectrum disorder (ASD) however, has struggled to define this difference, or derive clear-cut boundaries between autism and non-autism. Consequently, restructuring or disbanding the ASD diagnosis is becoming increasingly advocated within research. Nonetheless, autism now exists as a salient social construction, of which 'difference' is a key facet. Clinical and educational professionals must influence this cautiously, as changes to autism's social construction may counterproductively affect the quality of life of autistic people. This paper therefore reviews ASD's value as both neuropsychological and social constructs. Although lacking neuropsychological validity, the autism label may be beneficial for autistic self-identity, reduction of stigma, and administering support. Whilst a shift away from case-control ASD research is warranted, lay notions of 'different brains' may be preserved.

Neurodevelopmental disorders and comorbidity in young adults attending a psychiatric outpatient clinic

"Missed" cases with neurodevelopmental disorders (NDDs) within adult psychiatry services have attracted increasing attention in the last decade. Key questions have been what the prevalence of NDDs (particularly attention-deficit/hyperactivity disorder/ADHD and autism spectrum disorder/ASD) is, and what the clinical and gender characteristics of those with NDD in adult psychiatry are. All first-time attenders at an adult psychiatry clinic serving 18-25 years old were invited to take part in the study regardless of cause of concern. Participation in the study included diagnostic in-depth evaluation performed by experienced adult psychiatrists. Clinical diagnoses (DSM-IV-TR and DSM-5 criteria) were based on all available information (clinical psychiatric interview, clinical observation, and self-rating questionnaires). Almost two thirds (63%) of the study group met criteria for ADHD or ASD. Most of the patients with NDD (particularly the "NDD females") had not been diagnosed in childhood. Twelve percent of the females included had been given an ADHD diagnosis in childhood. In the current study we found that 48% of the females had ADHD. The high male:female NDD ratio reported among children, was not obvious in our NDD group. The results underscore the importance of screening for NDD in adult psychiatric services regardless of referral reason.

Dimensions of Autistic Traits Rated by Parents of Children and Adolescents with Suspected Autism Spectrum Disorders

To examine the factor structure of autism spectrum disorder (ASD) and the psychometric properties of the German Symptom Checklist for Autism Spectrum Disorders (SCL-ASD). Data were collected from 312 clinical referrals with suspected ASD (2–18 years). Confirmatory factor analyses and analyses of reliability, convergent and divergent validity were performed. A bifactor model with one general ASD factor and two specific factors (interaction-communication; restricted, repetitive behaviors) provided an adequate data fit. Internal consistencies of the SCL-ASD subscales and the total scale were > .70. Correlations with measures of ASD traits were higher than correlations with measures of externalizing and internalizing symptoms. The results support a factor structure consistent with DSM-5/ICD-11 criteria. The SCL-ASD has sound psychometric properties.

Social Cognition and Friendships in Adolescents With Autistic-Like Experiences and Psychotic-Like Experiences

Autism spectrum conditions (ASC) and schizophrenia spectrum conditions (SSC) are both characterized by changes in social-cognitive functioning. Less is known about the overlap and the differences in social-cognitive functioning when comparing individuals with subclinical levels of ASC and SSC, while studies in non-clinical samples have the benefit of avoiding confounds that are present in clinical groups. Therefore, we first examined how autistic-like experiences, positive psychotic-like experiences and the co-occurrence of both correlated with the performance on an extensive battery of social cognition tasks in young adolescents. Second, we examined the effect of autistic-like experiences, psychotic-like experiences and their co-occurrence on friendships in daily life. A total of 305 adolescents (Mage = 12.6, sd = 0.4, 147 boys) participated in the current study. A battery of social cognition tasks, comprising the Reading the Mind in the Eyes task, Dot perspective task and trust game were individually administered in a classroom setting, along with a friendship peer nomination questionnaire. Results indicated no evidence for a relationship between the performance on the social cognition battery and subclinical experiences of autism and/or psychosis. However, results did show that the amount of autistic-like experiences of adolescents were associated with being less often selected as a friend by their peers. By contrast, no relationship between self-reported friendships and autistic-like experiences was found. Neither a relationship between friendships and psychotic-like experiences was reported. This study provides initial evidence that information provided by peers may shed light on (altered) social behavior associated with autistic-like experiences that is not apparent on performance measures, as well as elucidate possible differences between autistic- and psychotic-like experiences.

Psychosocial characteristics differentiate non-distressing and distressing voices in 10,346 adolescents

Adolescents hearing non-existent voices may be at risk for psychosis, but the prevalence of voice-hearing (VH) in the general population complicates clinical interpretations. Differentiating between VH with and without distress may aid treatment decisions in psychosis services, but understanding the differences between these two phenomena as they present in the normal adolescent population is necessary to validate this differentiation. The present study compared VH with and without distress in 10,346 adolescents in relation to clinical characteristics, known risk factors, predictors and psychosocial moderators of psychosis. A population-based cohort of Norwegian 16-19 years old adolescents completed a comprehensive web-based questionnaire, including two questions from the extended Launay-Slade Hallucinations Scale: (1) I often hear a voice speaking my thoughts aloud and (2) I have been troubled by hearing voices in my head. Adolescents reporting no VH, non-distressing VH or distressing VH were compared on 14 psychosocial and clinical variables. A multinomial regression model showed that non-disturbing voices were predicted by better school grades, social dysfunction, distractibility, affective symptoms and experience of trauma, while the disturbing voices were predicted by the experience of bullying and trauma, perceived negative self-worth and self-efficacy, less family support, dysregulation of activation, distractibility, self-harm and anxiety. Hearing voices without distress versus being distressed by the voices is related to different constellations of psychosocial variables, suggesting that they represent two separate groups of adolescents. The findings validate the emphasis on distress in clinical practice.

ASD Validity

ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.

Do the Autism Spectrum Quotient (AQ) and Autism Spectrum Quotient Short Form (AQ-S) Primarily Reflect General ASD Traits or Specific ASD Traits? A Bi-Factor Analysis

In the current study, we fit confirmatory bi-factor models to the items of the Autism Spectrum Quotient (AQ) and Autism Spectrum Quotient Short Form (AQ-S) in order to assess the extents to which the items of each reflect general versus specific factors. The models were fit in a combined sample of individuals with and without a clinical diagnosis of autism spectrum disorders. Results indicated that, with the exception of the Attention to Details factor in the AQ and the Numbers/Patterns factors in the AQ-S, items primarily reflected a general factor. This suggests that when attempting to estimate an association between a specific symptom measured by the AQ or AQ-S and some criterion, associations will be confounded by the general factor. To resolve this, we recommend using a bi-factor measurement model or factor scores from a bi-factor measurement whenever hypotheses about specific symptoms are being assessed.

Screening tools for autism spectrum disorders

Purpose

– Diagnosing autism spectrum disorder (ASD) is important over the whole life span. Standardized instruments may support the assessment process. The purpose of this paper is to describe English- and German-screening tools for ASD.

Design/methodology/approach

– PubMed was used to search for published tools and evidence on their diagnostic validity.

Findings

– Searches identified 46 screening tools for ASD. Most are designed for children, while only few measures are available for adults, especially those with additional intellectual disabilities. Many instruments are under-researched, although a small number such as the Modified Checklist for Autism in Toddlers and the SCQ have been widely examined in a variety of populations.

Originality/value

– The study identified and described a number of ASD screeners that can support clinicians or researchers when deciding whether to carry out a more comprehensive ASD assessment.

Driving behaviors in adults with autism spectrum disorders

This pilot study investigated driving history and driving behaviors between adults diagnosed with autism spectrum disorders (ASD) as compared to non-ASD adult drivers. Seventy-eight licensed drivers with ASD and 94 non-ASD comparison participants completed the Driver Behavior Questionnaire. Drivers with ASD endorsed significantly lower ratings of their ability to drive, and higher numbers of traffic accidents and citations relative to non-ASD drivers. Drivers with ASD also endorsed significantly greater numbers of difficulties on the following subscales: intentional violations, F(1, 162) = 6.15, p = .01, η p (2)  = .04; mistakes, F(1, 162) = 10.15, p = .002, η p (2)  = .06; and slips/lapses, F(1, 162) = 11.33, p = .001, η p (2)  = .07. These findings suggest that individuals with ASD who are current drivers may experience more difficulties in driving behaviors and engage in more problematic driving behaviors relative to non-ASD drivers.