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Loizou S, Pemovska T, Stefanidou T, Foye U, Cooper R, Kular A, Greenburgh A, Baldwin H, Griffiths J, Saunders KRK, Barnett P, Minchin M, Brady G, Ahmed N, Parker J, Chipp B, Olive RR, Jackson R, Timmerman A, Sapiets S, Driskell E, Parsons B, Spain D, Totsika V, Mandy W, Pender R, Clery P, Trevillion K, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental healthcare for autistic people: systematic review. BJPsych Open 2024; 10:e128. [PMID: 39087319 DOI: 10.1192/bjo.2024.707] [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] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. AIMS To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. METHOD A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. RESULTS A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. CONCLUSION Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.
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Affiliation(s)
- Sofia Loizou
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Una Foye
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Ruth Cooper
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Jessica Griffiths
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Katherine R K Saunders
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | | | - Gráinne Brady
- Division of Psychiatry, University College London, UK
| | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, UK; and School of Health and Psychological Sciences, City, University of London, UK
| | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, UK
| | - Rachel R Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK; and University of Wolverhampton, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | | | | | | | - Vaso Totsika
- Division of Psychiatry, University College London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, London, UK
| | - Kylee Trevillion
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Alan Simpson
- National Institute for Health and Care Research (NIHR) Mental Health Policy Research Unit, King's College London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, London, UK
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Pemovska T, Loizou S, Appleton R, Spain D, Stefanidou T, Kular A, Cooper R, Greenburgh A, Griffiths J, Barnett P, Foye U, Baldwin H, Minchin M, Brady G, Saunders KRK, Ahmed N, Jackson R, Olive RR, Parker J, Timmerman A, Sapiets S, Driskell E, Chipp B, Parsons B, Totsika V, Mandy W, Pender R, Clery P, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis. Psychol Med 2024:1-31. [PMID: 38757186 DOI: 10.1017/s0033291724001089] [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: 05/18/2024]
Abstract
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
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Affiliation(s)
- Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sofia Loizou
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | | | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Matilda Minchin
- Division of Psychiatry, University College London, London, UK
| | - Gráinne Brady
- Division of Psychiatry, University College London, London, UK
| | | | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- School of Health and Psychological Sciences, City, University of London, London, UK
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Suzi Sapiets
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | | | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Kildahl AN, Helverschou SB. Post-traumatic stress disorder and experiences involving violence or sexual abuse in a clinical sample of autistic adults with intellectual disabilities: Prevalence and clinical correlates. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1075-1089. [PMID: 37609889 PMCID: PMC11067401 DOI: 10.1177/13623613231190948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
LAY ABSTRACT Post-traumatic stress disorder is a mental health disorder that may be triggered by the experience of events perceived as terrifying or overwhelming. Examples of such events include being the victim of violence or sexual abuse. Compared with other people, autistic people have increased risk of being exposed to violence or sexual abuse. In addition, autistic people may be more vulnerable to developing post-traumatic stress disorder following such exposure. However, knowledge is limited concerning the prevalence of experiences involving violence and sexual abuse, and post-traumatic stress disorder, in autistic people with co-occurring intellectual disabilities. Detection of these experiences, and identification of post-traumatic stress disorder, may be challenging in these individuals, and previous research indicates that post-traumatic stress disorder symptoms may be overlooked or misinterpreted. In this study, we examined prevalence of post-traumatic stress disorder, violence and sexual abuse in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only 3.4% were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of 'challenging' behaviours. These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment, and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.
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Bakken TL, Askeland Hellerud JM, Kildahl AN, Solheim-Inderberg AM, Hove O, Berge Helverschou S. Schizophrenia in Autistic People with Intellectual Disabilities. Treatment and Interventions. J Autism Dev Disord 2024:10.1007/s10803-024-06286-6. [PMID: 38393435 DOI: 10.1007/s10803-024-06286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Autistic people with intellectual disabilities appear to be at increased risk of schizophrenia. While current recommendations emphasize adapting interventions used for people with schizophrenia in general, few studies to date have investigated treatment of co-occurring schizophrenia in this specific population. To explore what interventions are provided to autistic people with intellectual disabilities and co-occurring schizophrenia in specialized mental health services, and to investigate whether changes in mental health symptoms and challenging behavior occurred during treatment. Using data from a longitudinal, national multicenter study, interventions provided to 26 autistic individuals with intellectual disabilities and co-occurring schizophrenia were explored. Symptoms were measured using the Psychopathology in Autism Checklist (PAC) and the Aberrant Behavior Checklist ABC) at referral (T1), at the end of treatment (T2), and at follow-up 12 months after T2 (T3). A broad range of interventions were provided to the participants, including inpatient admission, psychopharmacological treatment, various psychosocial interventions, and supportive interventions. Scores on the PAC and ABC were significantly lower at T2 than T1 for most scales, and no significant change was found from T2 to T3.Treatment of co-occurring schizophrenia appears feasible and effective in autistic people with intellectual disabilities.
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Bakken TL, Kildahl AN, Ludvigsen LB, Bjørgen TG, Dalhaug C, Hellerud JMA, Hove O, Solheim-Inderberg AM, Karlsen K, Helverschou SB. Schizophrenia in autistic people with intellectual disabilities: Symptom manifestations and identification. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1076-1091. [PMID: 37264713 DOI: 10.1111/jar.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/17/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The assessment of schizophrenia in autistic people with intellectual disabilities is challenging. This study aimed to explore the identification of schizophrenia in this population. METHODS Using data from a clinical multi-centre study, reported symptoms in 26 autistic individuals with intellectual disabilities diagnosed with co-occurring schizophrenia were explored. Scores on two checklists (Psychopathology in Autism Checklist [PAC], Aberrant Behaviour Checklist [ABC]) were compared with two comparison groups: autistic individuals with intellectual disabilities and other mental disorders (94), or no mental disorder (63). RESULTS Reported symptoms of schizophrenia in this population met the formal diagnostic criteria. For PAC/ABC scales, only PAC psychosis differed for the schizophrenia group. Among participants with schizophrenia, two were diagnosed with additional mental disorders. Elevated scores for anxiety and depression were common. CONCLUSIONS Emphasising core symptoms seems necessary when assessing co-occurring schizophrenia in autistic people with intellectual disabilities. The PAC may serve as a helpful screening tool.
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Affiliation(s)
- Trine Lise Bakken
- Oslo University Hospital, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Tale Gjertine Bjørgen
- St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
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6
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Adams D, Dargue N, Paynter J. Longitudinal studies of challenging behaviours in autistic children and adults: A systematic review and meta-analysis. Clin Psychol Rev 2023; 104:102320. [PMID: 37515997 DOI: 10.1016/j.cpr.2023.102320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
Autistic children and adults are at increased risk of showing behaviours that may be described as challenging, however, little is known about whether or how these behaviours may change over time. Given the profound impact that challenging behaviour can have on both the autistic individual and their support network, it is critical that the trajectory of challenging behaviours be better understood. This systematic review and meta-analysis identified and synthesised observational longitudinal studies of challenging behaviour in autistic individuals. Fifty-six studies were included in the systematic review, and the effect sizes of 37 independent samples arising from 34 of these reports were examined through meta-analysis. Crucially, across the 37 samples, scores on the measures of challenging behaviour reduced by a small, yet significant, extent over time. Although age of the sample at baseline assessment did not moderate the effect, the time between the baseline assessment and final follow-up and age at final follow-up both moderated the magnitude of the effect, with challenging behaviour scores reducing to a larger extent in (a) studies with longer intervals between baseline and final follow-up and (b) studies with older samples at follow-up. The results from the current systematic review and meta-analysis have both theoretical and practical implications for understanding challenging behaviour over time in autistic individuals. Avenues for future research are also highlighted that may allow better understanding, and therefore support of, challenging behaviour in autistic individuals.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia.
| | - Nicole Dargue
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia
| | - Jessica Paynter
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; School of Applied Psychology and Hopkins Centre, Griffith University, Gold Coast, QLD 4222, Australia
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
- Correspondence:
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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Pukki H, Bettin J, Outlaw AG, Hennessy J, Brook K, Dekker M, Doherty M, Shaw SC, Bervoets J, Rudolph S, Corneloup T, Derwent K, Lee O, Rojas YG, Lawson W, Gutierrez MV, Petek K, Tsiakkirou M, Suoninen A, Minchin J, Döhle R, Lipinski S, Natri H, Reardon E, Estrada GV, Platon O, Chown N, Satsuki A, Milton D, Walker N, Roldan O, Herrán B, Cañedo CL, McCowan S, Johnson M, Turner EJ, Lammers J, Yoon WH. Autistic Perspectives on the Future of Clinical Autism Research. AUTISM IN ADULTHOOD 2022; 4:93-101. [PMID: 36601072 PMCID: PMC9242721 DOI: 10.1089/aut.2022.0017] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Heta Pukki
- European Council of Autistic People z.s., Prague, Czech Republic.,Address correspondence to: Heta Pukki, MEd, MSc, European Council of Autistic People z.s., Ječná 545/19, 120 00 Prague 2, Czech Republic
| | - Jorn Bettin
- Autistic Collaboration Trust, Auckland, New Zealand
| | - Avery Grey Outlaw
- Autistic Self-Advocacy Network, Washington, District of Columbia, USA
| | | | - Kabie Brook
- Autism Rights Group Highland, Inverness, Scotland, UK
| | - Martijn Dekker
- European Council of Autistic People z.s, Prague, Czech Republic
| | | | | | - Jo Bervoets
- Lees- en Adviesgroep Volwassenen Autisme vzw, Antwerpen, Belgium
| | - Silke Rudolph
- European Council of Autistic People z.s, Prague, Czech Republic
| | | | | | | | | | | | | | - Kosjenka Petek
- Incijativa za autizam i ostale neurodivergentnosti, Zagreb, Croatia
| | | | | | - Jo Minchin
- The National Autistic Taskforce, Lincoln, United Kingdom
| | | | | | - Heini Natri
- The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | | | | | - Ovidiu Platon
- Asociația suntAutist—Autismul explicat de autiști, Timisoara, Romania
| | - Nick Chown
- Independent Autism Research Group, Cradley Heath, United Kingdom
| | - Ayaya Satsuki
- Otoemojite Neurodiversity Self-Help Group, Tokyo, Japan
| | - Damian Milton
- The Participatory Autism Research Collective, Canterbury, United Kingdom
| | - Nick Walker
- California Institute of Integral Studies, San Francisco, California, USA
| | | | | | | | - Sue McCowan
- Autistic Doctors International, United Kingdom
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9
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Varcin KJ, Herniman SE, Lin A, Chen Y, Perry Y, Pugh C, Chisolm K, Whitehouse AJ, Wood SJ. Occurrence of psychosis and bipolar disorder in adults with autism: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 134:104543. [DOI: 10.1016/j.neubiorev.2022.104543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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Helverschou SB, Ludvigsen LB, Hove O, Kildahl AN. Psychometric properties of the Psychopathology in Autism Checklist (PAC). INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 67:318-326. [PMID: 34552727 PMCID: PMC8451646 DOI: 10.1080/20473869.2021.1910779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 05/03/2023]
Abstract
Psychiatric disorders in individuals with co-occurring autism spectrum disorders (ASD) and intellectual disability (ID) are common, but diagnosis presents many challenges. The Psychopathology in Autism checklist (PAC) is among the very few instruments specifically developed for this group of individuals. The psychometric properties of the PAC (i.e. criterion validity, specificity, sensitivity and predictive values) were explored by comparing scores with assessments on the Aberrant Behavior Checklist (ABC) and examining how well assessment by the PAC at referral predicts final clinical diagnoses. Results indicated a significant correlation with the ABC, further supporting the validity of the PAC. Sensitivity and Specificity for specific diagnoses were variable, although positive predictive value for "any diagnosis' was relatively high. The study confirms the potential value of the PAC as a screening checklist but highlights the need for clinical diagnosis to be based on a multimodal, multidisciplinary assessment.
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Affiliation(s)
- Sissel Berge Helverschou
- NevSom – Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnia, Oslo University Hospital, Oslo, Norway
| | - Linn Beate Ludvigsen
- Department of Psychiatry, Section Intellectual Disability and Autism, Vestre Viken Hospital Trust, Drammen, Norway
| | - Oddbjørn Hove
- Department of Research and Innovation/Department of Mental Health, Regional Section Autism and Intellectual Disability Mental Health, Helse Fonna Hospital Trust, Haugesund, Norway
| | - Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism and NevSom – Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnia, Oslo University Hospital, Oslo, Norway
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Kildahl AN, Oddli HW, Helverschou SB. Potentially traumatic experiences and behavioural symptoms in adults with autism and intellectual disability referred for psychiatric assessment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 107:103788. [PMID: 33091711 DOI: 10.1016/j.ridd.2020.103788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) more frequently experience potentially traumatic events (PTEs), and may be more vulnerable to trauma-related symptoms. However, it is unclear how such symptoms are captured on tools used for behavioural and psychiatric assessment in this population. AIMS To explore whether and how PTEs are associated with symptom reports in adults with ASD and ID. METHODS AND PROCEDURES Associations and group differences for death of a close relative and serious disease/injury in a close relative/caregiver/friend were explored in a clinical sample of 171 adults with ASD and ID referred for psychiatric assessment. Symptoms were measured using Aberrant Behavior Checklist (ABC) and Psychopathology in Autism Checklist (PAC). OUTCOMES AND RESULTS Disease/injury was associated with higher scores on ABC irritability, ABC hyperactivity and self-injurious behaviour. Death was associated with lower scores on ABC lethargy and ABC stereotypic behaviour. Some associations reached significance only when controlling for ASD, ID, or verbal language skills, but the identified associations were not robust. No associations were found for PAC. CONCLUSIONS AND IMPLICATIONS There is a risk of under-appreciating the impact of PTEs in this population unless ASD, ID and verbal language skills are taken into account.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway; NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.
| | | | - Sissel Berge Helverschou
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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