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Arnold SRC, Huang Y, Lawson LP, Higgins JM, Hwang YI(J, Richdale A, Trollor JN. Development of the Impact of Diagnosis Scale-Revised (IODS-R). Assessment 2024; 31:908-919. [PMID: 37700577 PMCID: PMC11092292 DOI: 10.1177/10731911231196486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
No tools quantify the experience, psychological, and practical impact of receiving a diagnosis from a non-deficit perspective. Autism is increasingly late diagnosed in adulthood. The Impact of Diagnosis Scale (IODS) was initially developed for borderline personality disorder. We aimed to develop a revised version suitable for autistic adults and potentially other diagnostic groups. Following a trial of a preliminary revision, the researchers and autistic research advisors co-produced an expanded pool of 46 items, scored on 7-point Likert-type scale, within 6 hypothesized domains. Scale reduction processes were applied to data from 125 formally diagnosed autistic adults. Following iterative rounds of factor analysis using maximum likelihood estimation with Promax rotation, 22 items were retained across 4 domains to comprise the IODS-R. The IODS-R adds new understanding to the experience of receiving an autism diagnosis in adulthood. It may be useful for evaluating diagnostic services and other diagnostic groups.
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Affiliation(s)
- Samuel R. C. Arnold
- School of Psychology, Western Sydney University, Bankstown, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lauren P. Lawson
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julianne M. Higgins
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Ye In (Jane) Hwang
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Amanda Richdale
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julian N. Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
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2
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Davies J, Cooper K, Killick E, Sam E, Healy M, Thompson G, Mandy W, Redmayne B, Crane L. Autistic identity: A systematic review of quantitative research. Autism Res 2024; 17:874-897. [PMID: 38334318 DOI: 10.1002/aur.3105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
Autism can be considered both a personal and social identity. Identifying the factors contributing to positive Autistic identity development is crucial given the potential implications for mental health and wellbeing. In this systematic review, we aimed to synthesize quantitative literature on Autistic identity to identify the (individual and environmental) factors associated with Autistic identity, and to ascertain the relationship between Autistic identity and mental health and wellbeing. A total of 3,617 studies were screened and 20 met our inclusion criteria. Results indicated that people developed a more positive Autistic identity when receiving external autism acceptance and external support. The association between individual factors and Autistic identity were largely nonsignificant or inconclusive, highlighting the need for broad support that meets the needs of a range of Autistic people, rather than specific subgroups. Importantly, positive Autistic identity was associated with improved mental health and wellbeing. Peer support and/or self-directed support resources may be valuable mechanisms for supporting Autistic people to cultivate a positive Autistic identity. The evaluation of such support, including the long-term impacts on identity development, will be a critical avenue for future research.
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Affiliation(s)
- Jade Davies
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, UK
| | - Estelle Killick
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Evelyn Sam
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | | | | | - Will Mandy
- Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK
| | | | - Laura Crane
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, University College London, London, UK
- Autism Centre for Education and Research (ACER), Department of Disability, Inclusion and Special Needs, School of Education, College of Social Sciences, University of Birmingham, UK
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3
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Huang Y, Arnold SRC, Foley KR, Trollor JN. A Qualitative Study of Adults' and Support Persons' Experiences of Support After Autism Diagnosis. J Autism Dev Disord 2024; 54:1157-1170. [PMID: 36484961 PMCID: PMC9734854 DOI: 10.1007/s10803-022-05828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Adulthood autism diagnosis has become increasingly common, but little is known about post-diagnosis support experiences and needs. We interviewed 19 autistic adults and 4 support persons on experiences of formal and informal post-diagnosis support. Reflexive thematic analysis was used to identify themes. Participants reported difficulties accessing suitable formal support, especially regarding education and employment. Informal support was helpful but created challenges in the relationships between autistic adults and support persons. For autistic adults, support from autistic peers fostered belonging and self-acceptance. We also identified complex interactions between adults' post-diagnosis identity development and support experiences as they resolved the dilemma between self-acceptance and a desire to change. Findings have important implications for services working with autistic adults and their families.
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Affiliation(s)
- Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| | - Samuel R C Arnold
- Department of Developmental Disability Neuropsychiatry (3DN), Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia.
| | - Kitty-Rose Foley
- Department of Developmental Disability Neuropsychiatry (3DN), Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
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4
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Leung FYN, Shah P, Mason D, Livingston LA. Re-examining the association between the age of learning one is autistic and adult outcomes. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:433-448. [PMID: 37317529 PMCID: PMC10851640 DOI: 10.1177/13623613231173056] [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: 06/16/2023]
Abstract
LAY ABSTRACT An interesting recent study found that people who learned they were autistic at a younger age felt more positive about their lives (i.e., had better quality of life) than those who learned at an older age. However, this study has some limitations: (a) the study only involved a fairly small group of university students, (b) whether 'learning one is autistic' referred to learning about one's diagnosis or receiving one's diagnosis was unclear, (c) the influence of other factors on the link between age of learning one is autistic and quality of life was not considered, and (d) the assessment of different areas of quality of life was limited. Addressing these limitations, we re-examined whether the age at which one learns they are autistic relates to quality of life in adulthood. Contrary to the previous study, we found the age at which one learns about their autism does not have a significantly independent impact on their quality of life as an adult. Rather, other factors (e.g., autistic traits, sex, and additional mental health conditions) may have a greater impact. Given our participant sample was larger and more diverse in age and education level compared to previous research, this finding is likely to be more applicable to autistic adults from different backgrounds. Importantly, however, we are not suggesting that individuals should be made aware of their diagnosis later than sooner. Getting a timely diagnosis remains crucial for autistic people and their families to access appropriate support.
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Cage E, Botha M, McDevitt L, King KN, Biscoe L, Tucker K, Pearson A. Diagnosis as a new beginning not an end: A participatory photovoice study on navigating an autism diagnosis in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231220418. [PMID: 38230649 DOI: 10.1177/13623613231220418] [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: 01/18/2024]
Abstract
LAY ABSTRACT Lots of people seek an autism diagnosis as an adult, and they often say that being diagnosed can be positively life-changing, but the experience of getting a diagnosis can be difficult. We often do not hear the views of people currently looking for a diagnosis, or talk to them about how diagnosis relates to their identity. In our study, we looked at experiences of people currently seeking an autism diagnosis in the UK. We used participatory methods, where six people seeking diagnosis were included as collaborators in the research. They took part in four different sessions, where they helped to shape the research, took part in interviews about their experiences and helped to analyse the patterns in all the interviews. We also used something called photovoice during the interviews, where they could use photos to show how they felt about navigating a diagnosis. We identified four common themes: (1) everyone had experienced some form of crisis before seeking diagnosis; (2) when they realised they were autistic, they felt seen; (3) the diagnostic process and criteria were not working, and they felt judged by clinicians and (4) there was limited support available after diagnosis. In another session, we identified actions that need to be taken which have implications for policy and practice, including improving the diagnostic process and criteria with autistic people, autistic people being listened to more by people like general practitioners and clinicians and diagnosis services needing to be more flexible and appreciate different aspects of someone's identity and neurodivergence.
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6
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Woods SEO, Estes A. Toward a more comprehensive autism assessment: the survey of autistic strengths, skills, and interests. Front Psychiatry 2023; 14:1264516. [PMID: 37867767 PMCID: PMC10587489 DOI: 10.3389/fpsyt.2023.1264516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Sara Eileen O'Neil Woods
- Autism Center, University of Washington, Seattle, WA, United States
- Institute on Human Development and Disability, University of Washington, Seattle, WA, United States
- Discover Psychology Services, Lacey, WA, United States
| | - Annette Estes
- Autism Center, University of Washington, Seattle, WA, United States
- Institute on Human Development and Disability, University of Washington, Seattle, WA, United States
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, United States
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7
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Wigham S, Ingham B, Le Couteur A, Wilson C, Ensum I, Parr JR. Consensus statements on optimal adult post-autism diagnosis support and services: Delphi process following a UK survey of autistic adults, relatives and clinicians. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:344-355. [PMID: 35670069 DOI: 10.1177/13623613221097502] [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: 02/02/2023]
Abstract
LAY ABSTRACT Research has identified types of support helpful to autistic people, for example, physical and mental health interventions, psycho-education, peer support, developing positive identities and affiliation with social groups. However, accessing suitable post-autism diagnosis support and services is extremely difficult. We asked autistic adults, relatives and clinicians about their experiences of receiving and delivering post-autism diagnosis support/services. In Stage 1, 343 autistic adults and 45 relatives completed a survey. They answered questions about their experiences of UK autism post-diagnosis support/services for adults within 12 months after receiving a diagnosis. Thirty-five clinicians completed a similar survey. Just over half of adults and relatives said there was a follow-up appointment or discussion about support after diagnosis. Fewer than 40% received any support/services in 12 months after diagnosis. We used information from the surveys to create 11 statements describing characteristics of appropriate adult post-autism diagnosis support/services. In Stage 2, we asked clinicians for their views on the statements - they agreed with all of them. For example, those adults are offered an additional follow-up meeting after diagnosis and have access to mental and physical health services. We shared results with autistic adults, relatives and clinicians at two events. Some autistic adults, relatives and clinicians were positive about post-autism diagnosis support/services. However, they described many areas for improvement. The study findings can be used to define, develop and improve the types of adult post-diagnosis support services.
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Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute, Newcastle University, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, UK
| | - Ian Ensum
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
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Oredipe T, Kofner B, Riccio A, Cage E, Vincent J, Kapp SK, Dwyer P, Gillespie-Lynch K. Does learning you are autistic at a younger age lead to better adult outcomes? A participatory exploration of the perspectives of autistic university students. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:200-212. [PMID: 35404160 DOI: 10.1177/13623613221086700] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
LAY ABSTRACT People learn they are autistic at different ages. We wanted to know if telling kids they are autistic earlier helps them feel better about their lives when they grow up. We are a team of autistic and non-autistic students and professors. Seventy-eight autistic university students did our online survey. They shared how they found out they were autistic and how they felt about being autistic. They also shared how they feel about their lives now. Around the same number of students learned they were autistic from doctors and parents. Students who learned they were autistic when they were younger felt happier about their lives than people who learned they were autistic when they were older. Students who learned they were autistic when they were older felt happier about being autistic when they first found out than people who did not have to wait as long. Our study shows that it is probably best to tell people they are autistic as soon as possible. The students who did our study did not think it was a good idea to wait until children are adults to tell them they are autistic. They said that parents should tell their children they are autistic in ways that help them understand and feel good about who they are.
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Affiliation(s)
- Tomisin Oredipe
- College of Staten Island, The City University of New York, USA
| | - Bella Kofner
- College of Staten Island, The City University of New York, USA
| | - Ariana Riccio
- The Graduate Center, The City University of New York, USA
| | | | | | | | | | - Kristen Gillespie-Lynch
- College of Staten Island, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
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9
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de Broize M, Evans K, Whitehouse AJ, Wray J, Eapen V, Urbanowicz A. Exploring the Experience of Seeking an Autism Diagnosis as an Adult. AUTISM IN ADULTHOOD 2022; 4:130-140. [PMID: 36605969 PMCID: PMC9645668 DOI: 10.1089/aut.2021.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Emerging research suggests that seeking an autism diagnosis as an adult is usually difficult and time-consuming but brings relief once a diagnosis is made. This study explored the experience of the pathway to an autism diagnosis during adulthood for adults living in Australia. Methods We conducted a qualitative phenomenological study and interviewed 13 adults who identified as autistic about their pathway to autism diagnosis in their mode of choice. Spoken interviews were transcribed verbatim, and transcripts were analyzed by using a thematic approach. Results Data analysis resulted in 6 themes and 20 meaning units that described the experiences of adults seeking an autism diagnosis in Australia. These themes involved two interwoven journeys that spanned before, during, and after the diagnostic process. The personal journey involved feeling different, considering autism, and living as autistic, whereas the clinical journey involved missed opportunities, varied diagnostic experiences, and absent supports. Conclusions Given the potential benefits for adults obtaining a formal autism diagnosis and accessing post-diagnostic supports, it is important that health professionals and governments collaborate to reduce access barriers and ensure adequate services are available. The findings from this study informed the development of Australia's national guideline for autism diagnosis.
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Affiliation(s)
- Matthew de Broize
- Queensland Centre for Intellectual and Developmental Disability, MRI-UQ, The University of Queensland The University of Queensland, South Brisbane, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Long Pocket Precinct, Indooroopilly, Australia
| | - Kiah Evans
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Long Pocket Precinct, Indooroopilly, Australia.,Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Australia.,School of Allied Health, Social Work and Speech Pathology, Curtin University, Bentley, Australia.,School of Allied Health, University of Western Australia, Crawley, Australia
| | - Andrew J.O. Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Long Pocket Precinct, Indooroopilly, Australia.,Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Australia
| | - John Wray
- Child Development Service, Child and Adolescent Health Service, West Perth, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Long Pocket Precinct, Indooroopilly, Australia.,Academic Unit of Child Psychiatry and South West Sydney Local Health District (AUCS) and Ingham Institute, Liverpool, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales (UNSW), Kensington, Australia
| | - Anna Urbanowicz
- Queensland Centre for Intellectual and Developmental Disability, MRI-UQ, The University of Queensland The University of Queensland, South Brisbane, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Long Pocket Precinct, Indooroopilly, Australia.,Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia.,Address correspondence to: Anna Urbanowicz, BSc(OT)Hons, PhD, Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia
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10
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Crompton CJ, Hallett S, McAuliffe C, Stanfield AC, Fletcher-Watson S. "A Group of Fellow Travellers Who Understand": Interviews With Autistic People About Post-diagnostic Peer Support in Adulthood. Front Psychol 2022; 13:831628. [PMID: 35369218 PMCID: PMC8964394 DOI: 10.3389/fpsyg.2022.831628] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Receiving a diagnosis of autism in adulthood can be a life changing event, impacting identity, relationships, and mental health. A lack of post-diagnostic support has been highlighted by autistic adults, their allies, clinicians, and service providers. It can be a source of distress for autistic adults, reinforcing feelings of social isolation and rejection. Peer support could be a cost-effective, flexible, and sustainable model to provide community-based support for autistic adults. However, there is little research on the value of peer support, despite calls from the autistic community. This qualitative study explored autistic experiences and needs post-diagnosis, identifying specific ways that peer support may benefit them, and exploring the limitations of peer support. Twelve autistic adults who had all received an autism diagnosis in adulthood completed a semi-structured interview focussing on the diagnostic experience, post-diagnostic support needed and provided, engagement with the autistic community, and post-diagnostic peer support. Thematic analysis of interview transcripts resulted in four themes: (1) Mismatch in support needed and provided; (2) Community connection; (3) Flexible and personalised support; and (4) Sustainability. Participants indicated that peer support may be a useful mechanism to support autistic adults’ post-diagnosis and offers unique opportunities not available through other support channels. Though informal peer support exists, it could be more sustainable and effective if well-supported and funded.
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Affiliation(s)
- Catherine J Crompton
- Patrick Wild Centre, Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sonny Hallett
- The Autistic Mutual Aid Society Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew C Stanfield
- Patrick Wild Centre, Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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11
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Huang Y, Arnold SRC, Foley KR, Lawson LP, Richdale AL, Trollor JN. Factors associated with age at autism diagnosis in a community sample of Australian adults. Autism Res 2021; 14:2677-2687. [PMID: 34529351 DOI: 10.1002/aur.2610] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/20/2023]
Abstract
Autism diagnosis in adulthood has become increasingly common due to a range of factors including changes in awareness, diagnostic criteria, and professional practices. Past research identified a range of demographic and autism-related factors associated with autism diagnosis age in children. However, it is unclear whether these apply to autistic adults. This study aimed to examine predictors of autism diagnosis age in adults while controlling for current age and autistic traits. We used a cross-sectional sample of 657 adults aged 15-80 from three self and carer-report studies: the Australian Longitudinal Study of Autism in Adulthood (ALSAA), Study of Australian School-Leavers with Autism (SASLA) and Pathways, Predictors and Impact of Receiving an Autism Spectrum Diagnosis in Adulthood (Pathways). Using hierarchical multiplicative heteroscedastic regression, we found that older current age and higher self-reported autistic traits predicted older diagnosis age, and that female gender, lack of intellectual disability, language other than English, family history of autism, lifetime depression, and no obsessive-compulsive disorder predicted older diagnosis age beyond current age and autistic traits. The paradoxical relationship between high autistic traits and older diagnosis age requires further investigation. Based on these findings, we recommended strategies to improve autism recognition in women and people from non-English-speaking backgrounds. Future studies could extend the findings by examining the effects of childhood and adulthood socioeconomic status on adult diagnosis age.
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Affiliation(s)
- Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Samuel R C Arnold
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Kitty-Rose Foley
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - Lauren P Lawson
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Amanda L Richdale
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
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12
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Jellett R, Muggleton J. Implications of Applying "Clinically Significant Impairment" to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice. J Autism Dev Disord 2021; 52:1412-1421. [PMID: 33893595 DOI: 10.1007/s10803-021-04988-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
The addition of 'clinically significant impairment' (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, Author, 2013) to the diagnostic criteria for autism in DSM-5 attempts to establish a threshold for the condition. However, the increased prominence of the neurodiversity paradigm and social model of disability runs counter to the idea that characteristics of autism are fundamentally impairing. Consequently, diagnostic criteria for autism are becoming misaligned with the contemporary views of 'disorder' and 'disability'. In this commentary, we outline six clinical issues that arise from this misalignment during diagnostic assessment for autism, and the tension this creates in making diagnostic decisions. We conclude by considering ways the 'clinically significant impairment' criterion could be changed, and the implications this would have on clinical practice, and the concept of autism.
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Affiliation(s)
- Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Joshua Muggleton
- Clinical Psychologist for NHS Fife, Lynebank Hospital, Halbeath Road, Dunfermline, Fife, KY11 4UW, Scotland.
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13
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Evans K, van der Meer L, Eggleston MJF, Taylor LJ, Thabrew H, Waddington H, Whitehouse AJO. A Survey of Autistic Adults from New Zealand on the Autism Diagnostic Process During Adolescence and Adulthood. J Autism Dev Disord 2021; 52:771-781. [PMID: 33788075 DOI: 10.1007/s10803-021-04983-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
The diagnostic experiences of autistic adults in New Zealand have not been investigated and little is known globally about autistic adults' satisfaction with the autism diagnostic process. This study describes the diagnostic experiences of 70 autistic adults living in New Zealand and explores how these experiences are related to satisfaction during three stages of the diagnostic process. The results show that autistic adults were reasonably satisfied with the early query and diagnostic assessment stages, but were dissatisfied with the post-diagnostic support stage, with significant unmet needs. Dissatisfaction during the post-diagnostic support stage was also related to satisfaction during previous stages and poor coordination of supports. Suggestions are made on how to improve the autism diagnostic pathway for autistic adults in New Zealand.
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Affiliation(s)
- Kiah Evans
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, WA, 6872, Australia. .,School of Allied Health, Curtin University, Perth, WA, Australia. .,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia.
| | - Larah van der Meer
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia.,Autism New Zealand, Lower Hutt, New Zealand.,School of Education, Victoria University of Wellington, Wellington, New Zealand
| | | | - Lauren J Taylor
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Hiran Thabrew
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, WA, 6872, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia.,School of Psychological Science, University of Western Australia, Perth, WA, Australia
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Pellicano E, Lawson W, Hall G, Mahony J, Lilley R, Davis C, Arnold S, Trollor J, Yudell M. Documenting the untold histories of late-diagnosed autistic adults: a qualitative study protocol using oral history methodology. BMJ Open 2020; 10:e037968. [PMID: 32474432 PMCID: PMC7264831 DOI: 10.1136/bmjopen-2020-037968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Receiving a diagnosis of autism in adulthood is increasingly common for a subset of individuals who were either misdiagnosed in childhood or missed out on a diagnosis altogether. This qualitative study, coproduced with autistic people, invites late-diagnosed autistic adults to share their life histories to (1) understand better the consequences of living without a diagnosis, (2) elucidate what precipitates an autism diagnosis in mid-to-late adulthood and (3) identify the perceived impact of receiving that diagnosis. METHODS AND ANALYSIS Oral histories have been a successful way to uncover overlooked and marginalised voices. We therefore adopt qualitative, oral history methodology in this study to understand these adults' experiences, especially of living in an era when autism was not well known. We will recruit 24 participants who will (1) have been born before 1975, (2) have received a clinical, autism diagnosis after the age of 35, (3) be English-speaking and (4) have spent most of their childhood and adulthood living in Australia. Participants will take part in four sessions, including the main, qualitative, oral history interview, through a range of possible formats to facilitate inclusion. The interview data will be analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION The protocol has received institutional research ethics approval from Macquarie University's Human Research Ethics Committee (Ref.: 52019556310562). This study will yield understanding of the life experiences of autistic adults, especially middle-aged and older Australians, should inform more effective diagnostic practices and provide insight into the key factors that might promote resilience and enhance quality of life in autistic people. The findings will be disseminated to academic and clinical audiences through journal articles and conference presentations and to the autistic and autism communities through accessible reports. The interviews will also be prepared for digital archiving, which will enable ongoing access for future generations and communities.
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Affiliation(s)
- Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Wenn Lawson
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Gabrielle Hall
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Joanne Mahony
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Rozanna Lilley
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine Davis
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Samuel Arnold
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian Trollor
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yudell
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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