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Campbell AA, Karp SM, Mogos M. Feeding Behaviors in Infants and Toddlers Later Diagnosed with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2024:10.1007/s10803-024-06303-8. [PMID: 38635132 DOI: 10.1007/s10803-024-06303-8] [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: 02/19/2024] [Indexed: 04/19/2024]
Abstract
Children with autism spectrum disorder (ASD) are five times more likely to have feeding difficulties than neurotypical peers, although the majority of evidence describes feeding difficulty in children age 2 years and older. The purpose of this study is to systematically review the literature on feeding characteristics of children age 0-24 months who were later diagnosed with ASD with an emphasis on the measurement tools used to assess these feeding behaviors. We conducted a systematic review of the literature using PRISMA guidelines. Using selected keywords, a search was conducted using PubMed, PsycINFO, and CINAHL databases for relevant articles to identify feeding characteristics in infants and toddlers (age 0-24 months) later diagnosed with ASD. Sixteen studies were selected for this review by two independent reviewers. Among the selected studies, feeding difficulties were reported in all infant oral feeding modalities (breastfeeding, bottle feeding, and complementary feeding) by infants later diagnosed with ASD. However, the evidence was conflicting among studies regarding feeding characteristics, such as sucking differences while breastfeeding, use of the spoon with feedings, and preference of solid food texture, that presented in infants later diagnosed with ASD. A lack of consistent measurement of feeding behaviors in infants later diagnosed with ASD contributes to the difficulty in comparison across studies. Future research should focus on developing targeted, validated instruments for measuring feeding difficulty in this population with emphasis on breastfeeding and bottle feeding difficulty.
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Affiliation(s)
- Amy A Campbell
- Vanderbilt University School of Nursing, Nashville, TN, USA.
| | - Sharon M Karp
- Vanderbilt University School of Nursing, Nashville, TN, USA
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Lee NR, McQuaid GA, Grosman HE, Jayaram S, Wallace GL. Vocational Outcomes in ASD: An Examination of Work Readiness Skills as well as Barriers and Facilitators to Employment Identified by Autistic Adults. J Autism Dev Disord 2024; 54:477-490. [PMID: 36394783 PMCID: PMC9670084 DOI: 10.1007/s10803-022-05804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/18/2022]
Abstract
Little is known about work readiness skills among autistic adults. This study sought to address this by examining work readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers and facilitators to employment as articulated by a subset of autistic adults. Results revealed a variegated work readiness profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype, job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes for autistic adults.
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Affiliation(s)
- Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 119, Philadelphia, PA, 19104, USA.
| | - Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Hannah E Grosman
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 119, Philadelphia, PA, 19104, USA
| | - Sanjana Jayaram
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
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Hamilton J, Finch T, Le Couteur A, Mackintosh J, Petrou A, Garland D, Parr JR. The lived experiences of relatives of autistic adults, and their perceptions of their relationships with autistic adults across multiple age-related transitions and demands: A qualitative interview study with reflexive thematic analysis. PLoS One 2024; 19:e0294232. [PMID: 38241348 PMCID: PMC10798545 DOI: 10.1371/journal.pone.0294232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND There is a need to better understand autism across the life course, including the lives of both autistic people and supporting relatives. As part of a larger mixed methods cohort study involving autistic adults, carers and relatives this sub-study focused on the experiences of relatives alone to learn more about the lives of people from the wider personal networks. Our research questions were: 1. What are the experiences of family members who care for and/or support autistic adults, 2. How can the viewpoints of relatives add to what we know about transitions and challenges experienced by autistic adults, and 3. What strategies/support have been helpful for adults and relatives? METHODS Relatives of autistic adults were purposively sampled and recruited using the Relatives/Carers cohort from the Adult Autism Spectrum Cohort-UK. 18 participants aged 31-81years who were related to 16 autistic adults aged 18-57years were interviewed for 24-91minutes. Interview transcripts were examined using reflexive thematic analysis. MAIN FINDINGS Two overarching themes were developed, 'Family support goes a long way in caring for autistic adults' and 'When families turn to society for support' with subthemes. Relatives described benefits they had gained and their admiration for autistic adults. They reflected on how they gave support for independence in various contexts of dependence. They also identified the challenges that both autistic adults and families face navigating support systems (for example for healthcare and employment). An important novel outcome was the advocated value of role-models with lived experience who come from outside of the family. RECOMMENDATIONS The findings lead to recommendations for: (i) Strategies to reduce the barriers for support that are faced by autistic individuals and relatives during crisis points; (ii) recognition and support for what enables both relatives and autistic adults to function independently (e.g. funded activities, flexible employment); (iii) future planning conversations to include relatives who can enhance knowledge and help plan for future care or support needs for autistic adults and (iv) opportunities for role models (persons with lived experience, autistic adults and relatives) to inspire others and disseminate knowledge. CONCLUSIONS These findings add valuable insights into the experiences of relatives of autistic adults and challenge the reader to have greater appreciation of the many roles relatives can contribute across time and in a variety of contexts. These perspectives add important information for those working with and planning provision for autistic adults.
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Affiliation(s)
- Jahnese Hamilton
- Research and Development, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Ann Le Couteur
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Joan Mackintosh
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alex Petrou
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Deborah Garland
- Specialised Training Team, National Autistic Society, North East England, United Kingdom
| | - Jeremy R. Parr
- Research and Development, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Vuijk R, Turner W, Zimmerman D, Walker H, Dandachi-FitzGerald B. Schema therapy in adults with autism spectrum disorder: A scoping review. Clin Psychol Psychother 2024. [PMID: 38214936 DOI: 10.1002/cpp.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Schema therapy (ST) in adults with autism spectrum disorder (ASD) have gained increasing interest in clinical practice and research. However, to date, there has been no synthesis of the literature on ST as treatment for adults with ASD. Through a scoping review, we aim to summarize the emerging research and literature on ST for adults with ASD. METHODS A comprehensive literature search of three electronic databases was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications were included that examined ST in adults with ASD and non-clinical adults with autistic traits. RESULTS Systematic searches identified a total of 11 publications, all published since 2014, with the majority being conducted by Dutch and Japanese researchers. Of the 11 publications, 1 described an ST-informed social interaction training, 1 was an ST protocol, 2 described conceptual ST models, 2 were case examples, 2 examined early maladaptive schemas (EMSs) and 3 investigated the effectiveness of ST interventions. In summary, the theoretical exploration, practical examples of the application of ST and research findings with preliminary evidence of ST, EMSs and schema modes (SMs) in adults with ASD point towards the potential of ST for the treatment of adults with ASD. DISCUSSION The current scoping review highlights preliminary research findings and offers valuable suggestions for clinicians treating adults with ASD. This review underscores the need for development of and research in specialized ST protocols and programmes tailored to adults with ASD with chronic mental conditions, such as personality disorders (PDs).
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Wesley Turner
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - David Zimmerman
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Hugh Walker
- Minds & Hearts, Stones Corner, Queensland, Australia
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Ondruskova T, Royston R, Absoud M, Ambler G, Qu C, Barnes J, Hunter R, Panca M, Kyriakopoulos M, Oulton K, Paliokosta E, Sharma AN, Slonims V, Summerson U, Sutcliffe A, Thomas M, Dhandapani B, Leonard H, Hassiotis A. Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38329108 PMCID: PMC11017145 DOI: 10.3310/jkty6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. Objective To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. Design, setting, participants A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Intervention Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. Main outcome measure The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. Results We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. Limitations There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Conclusions Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Future work Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. Study registration This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Rachel Royston
- Division of Psychiatry, University College London, London, UK
| | - Michael Absoud
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University, University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- National and Kapodistrian University of Athens, Vyronas-Kessariani Community Mental Health Centre, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, UK
| | - Aditya Narain Sharma
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
| | - Vicky Slonims
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Helen Leonard
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Perna J, Bellato A, Ganapathy PS, Solmi M, Zampieri A, Faraone SV, Cortese S. Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis. Mol Psychiatry 2023; 28:5011-5023. [PMID: 37495888 DOI: 10.1038/s41380-023-02143-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/15/2023] [Accepted: 06/16/2023] [Indexed: 07/28/2023]
Abstract
AIM To conduct a systematic review and meta-analysis assessing whether vision and/or eye disorders are associated with Autism Spectrum Disorder (ASD). METHOD Based on a pre-registered protocol (PROSPERO: CRD42022328485), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 5th February 2022, with no language/type of document restrictions. We included observational studies 1) reporting at least one measure of vision in people of any age with a diagnosis of ASD based on DSM or ICD criteria, or ADOS; or 2) reporting the prevalence of ASD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random-effects meta-analyses were used for data synthesis. RESULTS We included 49 studies in the narrative synthesis and 46 studies in the meta-analyses (15,629,159 individuals distributed across multiple different measures). We found meta-analytic evidence of increased prevalence of strabismus (OR = 4.72 [95% CI: 4.60, 4.85]) in people with versus those without ASD (non-significant heterogeneity: Q = 1.0545, p = 0.7881). We also found evidence of increased accommodation deficits (Hedge's g = 0.68 [CI: 0.28, 1.08]) (non-significant heterogeneity: Q = 6.9331, p = 0.0741), reduced peripheral vision (-0.82 [CI: -1.32, -0.33]) (non-significant heterogeneity: Q = 4.8075, p = 0.4398), reduced stereoacuity (0.73 [CI: -1.14, -0.31]) (non-significant heterogeneity: Q = 0.8974, p = 0.3435), increased color discrimination difficulties (0.69 [CI: 0.27,1.10]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890), reduced contrast sensitivity (0.45 [CI: -0.60, -0.30]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890) and increased retinal thickness (=0.29 [CI: 0.07, 0.51]) (non-significant heterogeneity: Q = 0.8113, p = 0.9918) in ASD. DISCUSSION ASD is associated with some self-reported and objectively measured functional vision problems, and structural alterations of the eye, even though we observed several methodological limitations in the individual studies included in our meta-analyses. Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life. PROSPERO REGISTRATION CRD42022328485.
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Affiliation(s)
- John Perna
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alessio Bellato
- School of Psychology, University of Nottingham Malaysia, Selangor, Malaysia
| | - Preethi S Ganapathy
- Department of Ophthalmology & Visual Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Andrea Zampieri
- Vittorio Emanuele III Hospital - Montecchio Maggiore, Vicenza, Italy
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Man MQ, Yang S, Mauro TM, Zhang G, Zhu T. Link between the skin and autism spectrum disorder. Front Psychiatry 2023; 14:1265472. [PMID: 37920540 PMCID: PMC10619695 DOI: 10.3389/fpsyt.2023.1265472] [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] [Received: 07/30/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Autism spectrum disorder (ASD) is a common neurological disorder. Although the etiologies of ASD have been widely speculated, evidence also supports the pathogenic role of cutaneous inflammation in autism. The prevalence of ASD is higher in individuals with inflammatory dermatoses than in those without inflammatory diseases. Anti-inflammation therapy alleviates symptoms of ASD. Recent studies suggest a link between epidermal dysfunction and ASD. In the murine model, mice with ASD display epidermal dysfunction, accompanied by increased expression levels of proinflammatory cytokines in both the skin and the brain. Children with ASD, which develops in their early lifetime, also exhibit altered epidermal function. Interestingly, improvement in epidermal function alleviates some symptoms of ASD. This line of evidence suggests a pathogenic role of cutaneous dysfunction in ASD. Either an improvement in epidermal function or effective treatment of inflammatory dermatoses can be an alternative approach to the management of ASD. We summarize here the current evidence of the association between the skin and ASD.
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Affiliation(s)
- Mao-Qiang Man
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Department of Dermatology, University of California, San Francisco, CA, United States
- Dermatology Service, San Francisco VA Medical Center,San Francisco, CA, United States
| | - Shuyun Yang
- Department of Dermatology, The People’s Hospital of Baoshan, Baoshan, China
| | - Theodora M. Mauro
- Department of Dermatology, University of California, San Francisco, CA, United States
- Dermatology Service, San Francisco VA Medical Center,San Francisco, CA, United States
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tingting Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Curnow E, Utley I, Rutherford M, Johnston L, Maciver D. Diagnostic assessment of autism in adults - current considerations in neurodevelopmentally informed professional learning with reference to ADOS-2. Front Psychiatry 2023; 14:1258204. [PMID: 37867776 PMCID: PMC10585137 DOI: 10.3389/fpsyt.2023.1258204] [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] [Received: 07/14/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Services for the assessment and diagnosis of autism in adults have been widely criticized and there is an identified need for further research in this field. There is a call for diagnostic services to become more accessible, person-centered, neurodiversity affirming, and respectful. There is a need for workforce development which will increase capacity for diagnostic assessment and support for adults. ADOS-2 is a gold-standard diagnostic assessment tool for autism recommended in clinical guidelines. However, diagnostic procedures such as the ADOS-2 are rooted in the medical model and do not always sit comfortably alongside the neurodiversity paradigm or preferences of the autistic community. Training and educational materials need to account for the differences between these approaches and support clinicians to provide services which meet the needs of the adults they serve. The National Autism Implementation Team worked alongside ADOS-2 training providers to support clinicians in Scotland, to provide effective and respectful diagnostic assessment. The team engaged with clinicians who had attended ADOS training to identify areas of uncertainty or concern. Training materials were developed to support ADOS assessors to incorporate key principles including "nothing about us without us"; "difference not deficit"; "environment first"; "diagnosis matters," "language and mindsets matter"; and "a neurodevelopmental lens," to support the provision of neurodiversity affirming assessment practice. The National Autism Implementation Team also provided examples of actions which can be undertaken by clinicians to improve the assessment experience for those seeking a diagnosis. Training materials are based on research evidence, clinical experience, and the needs and wishes of autistic people.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Musselburgh, United Kingdom
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9
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Boilson AM, Churchard A, Connolly M, Casey B, Sweeney MR. Screening for Autism Spectrum Condition Through Inner City Homeless Services in the Republic of Ireland. J Autism Dev Disord 2023; 53:3987-3998. [PMID: 35948814 PMCID: PMC9365201 DOI: 10.1007/s10803-022-05669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Homeless service users were screened for autism spectrum disorder through one of Ireland's leading not for profit service providers. Keyworkers acted as proxy informants; their caseloads were screened using the DSM-5-Autistic Traits in the Homeless Interview (DATHI). Client current and historical health and behaviour data was collated. A representative sample of 106 eligible keyworkers caseloads were screened, identifying 3% "present" and 9% "possibly present" for autistic traits with the DATHI. These findings suggest a high estimate of autism prevalence and support emerging evidence that, people with autism are overrepresented in the homeless population, compared to housed populations. Autism may be a risk factor for entry into homelessness and a challenge to exiting homeless and engaging with relevant services.
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Affiliation(s)
- A M Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - A Churchard
- Buckinghamshire Older People's Psychological Services, Oxford Health NHS Foundation Trust, Whiteleaf Centre, Bierton Road, Aylesbury, HP20 1EG, UK
| | - M Connolly
- Dublin Simon Community, 5 Red Cow Lane Smithfield, Dublin 7, Ireland
| | - B Casey
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - M R Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
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10
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Ward JH, Weir E, Allison C, Baron-Cohen S. Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Mol Autism 2023; 14:35. [PMID: 37730651 PMCID: PMC10510241 DOI: 10.1186/s13229-023-00565-2] [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: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. METHOD We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini-Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. RESULTS There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. LIMITATIONS Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. CONCLUSIONS This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS.
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Affiliation(s)
- John H Ward
- Royal Devon University NHS Foundation Trust, Exeter, Devon, UK
- University of Exeter Medical School, Devon, UK
- University of Oxford, Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
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Curnow E, Rutherford M, Maciver D, Johnston L, Prior S, Boilson M, Shah P, Jenkins N, Meff T. Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS One 2023; 18:e0288275. [PMID: 37440543 PMCID: PMC10343158 DOI: 10.1371/journal.pone.0288275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Autistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community. OBJECTIVE This rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570). DATA SOURCES MEDLINE, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY CRITERIA English language; published 2011-2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults. APPRAISAL AND SYNTHESIS Bias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation. RESULTS Twenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as 'evidence based.' Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered. CONCLUSIONS There is some understanding of the scope of mental ill-health in autism, but interventions are not tailored to the needs of autistic adults, not evidence based, and may focus on promoting neurotypical behaviours rather than the priorities of autistic people.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh, United Kingdom
| | - Susan Prior
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marie Boilson
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Fife Health and Social Care Partnership, Lynebank Hospital, Dunfermline, Fife, United Kingdom
| | - Premal Shah
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, United Kingdom
| | - Natalie Jenkins
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Tamsin Meff
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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Mazurek MO, Pappagianopoulos J, Brunt S, Sadikova E, Nevill R, Menezes M, Harkins C. A mixed methods study of autistic adults' mental health therapy experiences. Clin Psychol Psychother 2023; 30:767-779. [PMID: 36708045 PMCID: PMC10372197 DOI: 10.1002/cpp.2835] [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: 10/13/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Autistic adults are at high risk for co-occurring mental health problems and need access to effective and appropriate mental health treatment. However, the relative effectiveness or acceptability of specific mental health strategies among autistic adults has not been previously examined. The current study sought to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health strategies using a mixed methods approach. Autistic adults (n = 303, ages 21-77) completed online surveys and open-ended questions about their mental health and therapy experiences. Most (88.8%) had participated in therapy, with cognitive approaches being the most common. Regarding overall therapy experiences, qualitative analyses revealed four primary themes and nine subthemes. Therapist acceptance and understanding were seen as critical for therapy success, and many participants felt that therapy was helpful for personal growth. However, many participants found that talking in session was challenging and noted that aspects of the session format affected their ability to engage in therapy. Regarding specific strategies, four cross-cutting themes and eight strategy-specific subthemes were identified. A variety of strategies were seen as helpful for reducing anxiety and improving mood. However, autistic adults reported trouble generalizing strategies to daily life and found some techniques to be difficult to implement due, in part, to their unique autism-related needs. As the first study of its kind, the results underscore the importance of establishing a safe and accepting therapeutic relationship, providing accommodations to support communication needs, and considering individual differences and preferences when selecting mental health strategies for autistic clients.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | | | - Sophie Brunt
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Rose Nevill
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Michelle Menezes
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Christina Harkins
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
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Friedman S, Noble R, Archer S, Gibson J, Hughes C. Respite and connection: Autistic adults' reflections upon nature and well-being during the Covid-19 pandemic. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231166462. [PMID: 37113030 PMCID: PMC10140763 DOI: 10.1177/13623613231166462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
LAY ABSTRACT The Covid-19 pandemic and associated lockdowns provided opportunities to spend time in nature, with many people reporting that this benefitted their well-being. However, existing research from the pandemic period has focused on the way general populations experienced nature; less is known about how autistic people used nature to support their well-being during the pandemic. We created a survey that invited autistic adults living in the United Kingdom to reply to text box questions. A total of 127 people responded to our survey; we analysed their responses using a method called reflexive thematic analysis and developed themes based on patterns among all the responses. We developed two themes: respite in nature and connecting amid widespread disconnection. For some autistic adults during the pandemic, nature provided physical distance from others or from crowded homes, which helped them reduce their stress. In addition, some participants felt more psychologically connected to nature itself during the pandemic, while for others, nature served as a way of connecting with others during a potentially isolating time. These findings are important for autistic people and their families and carers who may want to seek out nature-based activities to support well-being in the wake of the pandemic.
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Bishop SL, Lord C. Commentary: Best practices and processes for assessment of autism spectrum disorder - the intended role of standardized diagnostic instruments. J Child Psychol Psychiatry 2023; 64:834-838. [PMID: 37005008 DOI: 10.1111/jcpp.13802] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments.
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Affiliation(s)
- Somer L Bishop
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Van der Putten WJ, Geurts HM. A longitudinal study on cognitive aging in autism. Psychiatry Res 2023; 321:115063. [PMID: 36709700 DOI: 10.1016/j.psychres.2023.115063] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Longitudinal studies on cognitive aging in autism are scarce, and largely underpowered, yet essential to obtain more conclusive results on cognitive changes in autism during adulthood. In the largest longitudinal study on cognition thus far, we aimed to get more insight into cognitive aging in autism. As pre-registered, we computed reliable change indices (RCIs) and multilevel models to estimate cognitive changes in 128 autistic, and 112 non-autistic adults (range: 24-85 yrs.) over two to three timepoints (average interval: 3.5 yrs.). Participants were tested on 15 outcome measures, covering verbal memory, visual (working) memory, prospective memory, theory of mind, fluency, response speed, inhibition, planning, and switching. RCIs showed no significant differences between groups (autism/no-autism) in changes over time. Using multilevel models, most tasks showed sensitivity to cross-sectional age-related effects, and/or longitudinal changes, with worse performance at older age, and later timepoints. However, effects were not significantly different between the autism and no-autism group. This lack of group differences was substantiated by additional Bayesian analyses. In sum, the current study provides evidence for parallel (similar) cognitive aging in autism. Specifically, autistic individuals diagnosed in adulthood, without intellectual disability, do not seem at risk for accelerated cognitive decline.
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Affiliation(s)
- C Torenvliet
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - A P Groenman
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Research Institute Child Development and Education, University of Amsterdam, the Netherlands
| | - T A Radhoe
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - J A Agelink van Rentergem
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - W J Van der Putten
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
| | - H M Geurts
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
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Mai AS, Yau CE, Tseng FS, Foo QXJ, Wang DQ, Tan EK. Linking autism spectrum disorders and parkinsonism: clinical and genetic association. Ann Clin Transl Neurol 2023; 10:484-496. [PMID: 36738194 PMCID: PMC10109258 DOI: 10.1002/acn3.51736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Autism spectrum disorders (ASD) comprise many complex and clinically distinct neurodevelopmental conditions, with increasing evidence linking them to parkinsonism. METHODS We searched Medline and Embase from inception to 21 March 2022 and reviewed the bibliographies of relevant articles. Studies were screened and reviewed comprehensively by two independent authors. RESULTS Of 863 references from our search, we included eight clinical studies, nine genetic studies, and five case reports. Regardless of age group, Parkinson's disease (PD) and parkinsonian syndromes were more frequently observed in patients with ASD, though the evidence for increased rates of parkinsonism is less clear for children and adolescents. Parkinsonian features and hypokinetic behavior were common in Rett syndrome, with prevalence estimates ranging from 40% to 80%. Frequently observed parkinsonian features include bradykinesia, rigidity, hypomimia, and gait freezing. PD gene PARK2 copy number variations appear more frequently in ASD cases than controls. Evidence suggests that RIT2 and CD157/BST1 are implicated in ASD and PD, while the evidence for other PD-related genes (DRD2, GPCR37, the SLC gene family, and SMPD1) is less clear. Rare mutations, such as ATP13A2, CLN3, and WDR45, could result in autistic behavior and concomitant parkinsonism. CONCLUSION The prevalence of parkinsonism in ASD is substantially greater than in the general population or matched controls. Various PD-associated gene loci, especially PARK2, could confer susceptibility to ASD as well. Important future directions include conducting prospective cohort studies to understand how parkinsonian symptoms may progress, genetic studies to reveal relevant gene loci, and pathophysiologic studies to identify potential therapeutic targets.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fan Shuen Tseng
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore, Singapore
| | - Qi Xuan Joel Foo
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore, Singapore
| | - Dennis Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Southern Medical University, Guangzhou, China
| | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore, Singapore.,Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
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Development of a Novel Multi-Disciplinary Specialized Care Service for Children and Adolescents with Autism Spectrum Disorder and/or Intellectual/Developmental Disability in a Tertiary Children's Hospital Setting. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010057. [PMID: 36670608 PMCID: PMC9856852 DOI: 10.3390/children10010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
Children and adolescents with autism spectrum disorder (ASD) and/or Intellectual/Developmental Disability (IDD) are at greater risk of developing comorbid medical conditions, mental health diagnoses, behavioral challenges, and having overall poorer physical and mental health outcomes. Hospital environments present unique stressors and challenges for children and adolescents with ASD/IDD including a change in familiar environment, unpredictable routines, and exposure to sensory stimuli that may be overwhelming. While many school boards have specialized multi-disciplinary special needs support teams and services made up of professionals with expertise in supporting students with ASD/IDD, most hospitals do not have a formal multi-disciplinary ASD/IDD support team in place to support patients, families, and health care staff across the hospital. There is an emerging recognition of the need for specialized multi-disciplinary developmental-behavioral and mental health expertise in hospital inpatient settings. This paper describes the framework for the development of an innovative multi-disciplinary program to better support children and adolescents with ASD/IDD within a tertiary children's hospital setting.
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Itoi C, Ujiie Y, Matsushima K, Takahashi K, Ide M. Validation of the Japanese version of the Interoception Sensory Questionnaire for individuals with autism spectrum disorder. Sci Rep 2022; 12:21722. [PMID: 36522396 PMCID: PMC9755269 DOI: 10.1038/s41598-022-25883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
The Interoception Sensory Questionnaire (ISQ) is a self-report instrument used to assess the characteristics of interoceptive processing in individuals with autism spectrum disorder (ASD). Previous studies have shown that scores of the ISQ are more appropriate than other subjective measures for evaluating difficulties in interoceptive processing in individuals with ASD. Yet, no prior research has demonstrated the validation of the ISQ in Japanese samples. This study attempted to validate the Japanese version of the ISQ (ISQ-J) by examining its psychometric properties. We confirmed the score distribution, internal consistency, and factor structure in Japanese samples. We also examined the relationships with other interoceptive questionnaires. In addition, we compared the scores of the ISQ-J between adolescents and adults with ASD participants and control participants. Results of confirmatory factor analyses showed that the reliability of the ISQ-J in adults with ASD reached an acceptable level of a one-factor structure with excellent internal consistency (α = 0.963). The result of the ISQ-J showed a significant positive correlation with the measure of awareness of interoceptive sensitivity for localized bodily states; on the other hand, a significant negative correlation was found with those integrated bodily states. In addition, the ISQ-J scores were significantly higher in the ASD group than in the control group. The current findings depend on self-report data (including a diagnosis of ASD) to measure validity constructs. Additionally, since the ISQ-J was surveyed in adults with ASD, it is unclear whether similar the results would be obtained if the ISQ-J were conducted with children. These results indicate the validity and reliability of the ISQ-J and provide a tool for assessing confusion of interoceptive information in Japanese adults with ASD.
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Affiliation(s)
- Chihiro Itoi
- grid.419819.c0000 0001 2184 8682NTT Communication Science Laboratories, 3-1 Morinosato Wakamiya, Atsugi, Kanagawa 243-0198 Japan ,grid.419714.e0000 0004 0596 0617National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama 359-8555 Japan
| | - Yuta Ujiie
- grid.262564.10000 0001 1092 0677College of Contemporary Psychology, Rikkyo University, 1-2-26 Kitano, Niiza-shi, Saitama, 352-8558 Japan ,grid.262576.20000 0000 8863 9909Research Organization of Open Innovation and Collaboration, Ritsumeikan University, 2-150 Iwakura-Cho, Ibaraki, Osaka 567-8570 Japan
| | - Kanae Matsushima
- grid.410783.90000 0001 2172 5041Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashi-Cho, Hirakata, Osaka 573-1136 Japan
| | - Kohske Takahashi
- grid.262576.20000 0000 8863 9909College of Comprehensive Psychology, Ritsumeikan University, 2-150 Iwakura-Cho, Ibaraki, Osaka 567-8570 Japan
| | - Masakazu Ide
- grid.419714.e0000 0004 0596 0617National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama 359-8555 Japan
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Views about primary care health checks for autistic adults: UK survey findings. BJGP Open 2022; 6:BJGPO.2022.0067. [PMID: 35618408 PMCID: PMC9904800 DOI: 10.3399/bjgpo.2022.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Compared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes. AIM To establish the views of autistic people towards a primary care health check for autistic people. DESIGN & SETTING Cross-sectional questionnaire study in England and Wales. METHOD A questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire. RESULTS Most responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician's autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible. CONCLUSION Autistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.
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The indirect effect of self-compassion in the association between autistic traits and anxiety/depression: A cross-sectional study in autistic and non-autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221132109. [DOI: 10.1177/13623613221132109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study followed a pre-registered analysis plan with the aim to investigate whether autistic traits and self-compassion are correlated in autistic adults, and to test an indirect effect of autistic traits on anxiety/depression via self-compassion. We present the findings of an online survey of 456 participants ( n = 228 autistic adults, n = 228 non-autistic adults) who completed the Autism Spectrum Quotient (AQ), the Self-Compassion Scale (SCS) and the Hospital Anxiety and Depression Scale (HADS). Lower self-compassion was reported by autistic participants compared to non-autistic participants, and a negative correlation was found between autistic traits and self-compassion in both groups. Furthermore, an indirect association between autistic traits and anxiety/depression via self-compassion was observed in both samples. Considering that many autistic people experience co-occurring anxiety and depression, and that self-compassion is a skill that can be cultivated with practice, the findings of this study suggest that self-compassion may be a modifiable factor that could improve the mental health of this population. Lay abstract Previous research on non-autistic adults suggests self-compassion may serve to reduce mental health problems and promote psychological well-being. Correlations between autistic traits and self-compassion have been observed in non-clinical populations. In this study, we were interested in extending previous research by exploring relationships between autistic traits, self-compassion and anxiety/depression in autistic adults without intellectual disability. The findings revealed that on average autistic people reported lower self-compassion than non-autistic people. Once we accounted for levels of self-compassion in our statistical model, this resulted in a complete loss of statistical significance in the relationships between autistic traits and anxiety/depression. Self-compassion may be a useful target for clinical intervention in autistic adults with co-occurring mental health difficulties.
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Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum’s capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives. The focus on functional deficits in conventional autism research constrains understanding of autistic lives. In this Review, Pellicano et al. appraise research on autistic adulthood through a capabilities lens to identify areas where autistic adults thrive, and where more research and services are needed to enhance their quality of life.
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Weir E, Allison C, Baron-Cohen S. Autistic adults have poorer quality healthcare and worse health based on self-report data. Mol Autism 2022; 13:23. [PMID: 35619147 PMCID: PMC9135388 DOI: 10.1186/s13229-022-00501-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent research suggests that autistic individuals have shorter lifespans and experience worse health (greater health burden) than non-autistic individuals. Small, qualitative studies suggest that autistic adults also experience poor self-reported healthcare quality. METHODS An anonymized, cross-sectional, self-report questionnaire was administered to n = 4158 individuals. The study assessed prevalence of chronic health conditions, healthcare quality, differences in overall health inequality score, and effects of the coronavirus pandemic on healthcare quality. We used Fisher's exact tests, binomial logistic regression, and predictive machine learning tools, as appropriate. RESULTS The final sample included n = 2649 participants (n = 1285 autistic) aged 16-96 years. Autistic adults reported lower quality healthcare than non-autistic adults across 50/51 items, including poorer access to healthcare and poorer communication, alongside increased anxiety, sensory sensitivity, system-level problems, shutdowns, and meltdowns. Differences between groups were stark: aggregated health inequality scores predicted autism diagnosis, even after stratifying by sex. Autistic adults were also more likely to have chronic health conditions than non-autistic adults. There were no significant differences in healthcare quality for autistic adults before and during the pandemic, although they received relatively poorer quality healthcare than non-autistic adults across both periods. LIMITATIONS The study's sampling methods are not likely to capture the perspectives of all autistic individuals, especially those with intellectual disability. Both the autistic and control samples are biased towards UK residents, white individuals, those assigned female at birth, and those who completed an undergraduate degree or higher education. As such, these results may limit their generalizability to other groups. Finally, these results relate to self-reported differences in healthcare quality between autistic and non-autistic adults. The observed group differences may in part reflect differences in perception and communication rather than differences in actual healthcare quality. CONCLUSIONS Autistic adults are more likely to have chronic health conditions alongside self-reported lower quality healthcare than others. Health inequalities between these groups are widespread and dramatic; unfortunately, they existed before and have persisted after the onset of the coronavirus pandemic.
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Affiliation(s)
- Elizabeth Weir
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK.
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
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23
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Cooper SA, Henderson A, Kinnear D, Mackay D, Fleming M, Smith GS, Hughes-McCormack LA, Rydzewska E, Dunn K, Pell JP, Melville C. Cohort profile: Scotland's record-linkage e-cohorts of people with intellectual disabilities, and autistic people (SCIDA). BMJ Open 2022; 12:e057230. [PMID: 35568493 PMCID: PMC9109103 DOI: 10.1136/bmjopen-2021-057230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To investigate health, mortality and healthcare inequalities experienced by people with intellectual disabilities, and autistic people, and their determinants; an important step towards identifying and implementing solutions to reduce inequalities. This paper describes the cohorts, record-linkages and variables that will be used. PARTICIPANTS Scotland's Census, 2011 was used to identify Scotland's citizens with intellectual disabilities, and autistic citizens, and representative general population samples with neither. Using Scotland's community health index, the Census data (demography, household, employment, long-term conditions) were linked with routinely collected health, death and healthcare data: Scotland's register of deaths, Scottish morbidity data 06 (SMR06: cancer incidence, mortality, treatments), Prescribing Information System (identifying asthma/chronic obstructive pulmonary disease; angina/congestive heart failure/hypertension; peptic ulcer/reflux; constipation; diabetes; thyroid disorder; depression; bipolar disorders; anxiety/sleep; psychosis; attention deficit hyperactivity disorder; epilepsy; glaucoma), SMR01 (general/acute hospital admissions and causes, ambulatory care sensitive admissions), SMR04 (mental health admissions and causes), Scottish Care Information-Diabetes Collaboration (diabetic care quality, diabetic outcomes), national bowel screening programme and cervical screening. FINDINGS TO DATE Of the whole population, 0.5% had intellectual disabilities, and 0.6% were autistic. Linkage was successful for >92%. The resultant e-cohorts include: (1) 22 538 people with intellectual disabilities (12 837 men and 9701 women), 4509 of whom are children <16 years, (2) 27 741 autistic people (21 390 men and 6351 women), 15 387 of whom are children <16 years and (3) representative general population samples with neither condition. Very good general health was reported for only 3389 (15.0%) people with intellectual disabilities, 10 510 (38.0%) autistic people, compared with 52.4% general population. Mental health conditions were reported for 4755 (21.1%) people with intellectual disabilities, 3998 (14.4%) autistic people, compared with 4.2% general population. FUTURE PLANS Analyses will determine the extent of premature mortality, causes of death, and avoidable deaths, profile of health conditions and cancers, healthcare quality and screening and determinants of mortality and healthcare.
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Affiliation(s)
- Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gillian S Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Watkins LV, O'Dwyer M, Shankar R. A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism. Expert Opin Pharmacother 2022; 23:841-851. [PMID: 35341433 DOI: 10.1080/14656566.2022.2055461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype. AREAS COVERED This review explores the evidence for common genetic etiologies and pathophysiological pathways in relation to both epilepsy and autism. Autism with comorbid epilepsy are associated with a high prevalence of medical and psychiatric comorbidities. This paper discusses how this influences assessment, treatment, and outcomes. The evidence for the treatment of specific seizure types in the context of NDDs is also examined alongside clinical commentary. EXPERT OPINION Despite the strong association, there is a limited evidence base to support the efficacy and tolerability of anti-seizure medications specifically in autism, with no Level 1 evidence or National Guidance available. Autism and epilepsy should be approached under a NDD model with cautious introduction and titration of anti-seizure medication. Alongside this, there is evidence to support a move toward precision medicine in specific genetic syndromes such as Tuberous Sclerosis Complex and other genetic seizure disorders. The first-line treatments that should be considered for focal seizures include carbamazepine, lamotrigine, and levetiracetam.
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Affiliation(s)
- Lance V Watkins
- Epilepsy Specialist Service Swansea Bay University Health Board, Cardiff, UK
| | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College, Dublin 2, Ireland
| | - Rohit Shankar
- Department of Intellectual Disability Neuropsychiatry, Cornwall Partnership NHS Foundation Trust, Truro, UK.,Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Medical School, Truro, UK
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25
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Healthcare barriers, what about older age? A comment on Malik-Soni et al. Pediatr Res 2022; 91:1025-1027. [PMID: 34108624 PMCID: PMC9122813 DOI: 10.1038/s41390-021-01596-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 02/01/2023]
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26
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Van der Putten WJ, Geurts HM. Parallel age-related cognitive effects in autism: A cross-sectional replication study. Autism Res 2021; 15:507-518. [PMID: 34862853 PMCID: PMC9300037 DOI: 10.1002/aur.2650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Abstract
Findings on age-related cognitive effects in autism in adulthood are inconsistent across studies. As these studies substantially differ in their methodology, replication studies are needed. In this replication study frequentist (i.e., null-hypothesis significance testing), and Bayesian statistics were used to investigate the hypothesis that in autistic adults compared to non-autistic adults mostly parallel, but also protective age-related cognitive effects can be observed. Participants were 88 autistic adults, and 88 non-autistic matched comparisons (age range: 30-89 years, mean age: 55 years). Cognitive measures were administered on the following six domains: verbal memory, visual memory, working memory, Theory of Mind (ToM), verbal fluency, and processing speed, and self-reported cognitive failures. Non-autistic adults outperformed autistic adults on ToM, verbal fluency, and verbal memory, but only the first two were confirmed with Bayesian replication analyses. Also, more cognitive failures were reported by autistic adults. No interactions between group and age were observed, suggesting a parallel age-related effect on all cognitive domains. In sum, previously observed difficulties in ToM and verbal fluency were replicated which seem to persist at older age. Previously reported parallel age-related cognitive patterns were replicated, yet no evidence for protective age-related patterns was found. LAY SUMMARY: We investigated whether our previous findings on cognitive aging in autism could be confirmed in a new study measuring the cognitive effects of age in autistic and non-autistic adults. As expected, tasks that younger autistic adults had difficulties with (theory of mind, fluency) were also difficult for older autistic adults, and the effect of age itself was similar in autistic and non-autistic adults. Unexpectedly, we observed no protective effects (less cognitive aging) in autism.
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Affiliation(s)
- Carolien Torenvliet
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Annabeth P Groenman
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tulsi A Radhoe
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A Agelink van Rentergem
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wikke J Van der Putten
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis, Autism Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
| | - Hilde M Geurts
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis, Autism Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
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Erwin J, Paisi M, Witton R, Neill S, Burns L, Vassallo I, Nelder A, Facenfield J, Devalia U, Vassallo T. Factors Influencing Oral Health Behaviours, Access and Provision of Dental Care for Autistic Children and Adolescents in Countries with a Very High Human Development Index: Protocol for a Mixed Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312346. [PMID: 34886072 PMCID: PMC8657110 DOI: 10.3390/ijerph182312346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Autistic children and adolescents are at high risk of dental disease and experience oral health inequalities. They consistently show high levels of unmet needs in relation to their oral health and access to dental care. There are no systematic reviews that bring together the evidence on the factors that influence oral hygiene behaviours, and access to and provision of dental care for autistic children and adolescents. A systematic search will be carried out in eight international databases and in grey literature of qualitative, quantitative and mixed method research studies from countries with a High Development Index which relate to oral health behaviours, and access to and provision of dental care. Only studies where participants are autistic children and adolescents aged 19 years or under, parents/guardians/caregivers, support staff, or oral health care providers will be included. Quantitative and qualitative data will be synthesized together through data transformation using a convergent integrated approach. Thematic synthesis will be used to carry out an inductive analysis of the data. The findings from the systematic review which this protocol generates will be used in the development of an appropriate local clinic care pathway for autistic children/adolescents and to inform national policies and practices. Prospero registration: CRD 42021248764.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Correspondence:
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Sarah Neill
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
| | - Isaac Vassallo
- School of Engineering, Computing and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Abigail Nelder
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Jemma Facenfield
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospital, London University, 47-49 Huntley St, London WC1E 6DG, UK;
| | - Tara Vassallo
- Plymouth Institute of Education, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- National Autistic Society—Plymouth & District Branch, Plymouth PL1 4QU, UK
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28
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. The Mental and Physical Health Profiles of Older Adults Who Endorse Elevated Autistic Traits. J Gerontol B Psychol Sci Soc Sci 2021; 76:1726-1737. [PMID: 32756953 DOI: 10.1093/geronb/gbaa112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The mental and physical health profile of autistic people has been studied in adolescence and adulthood, with elevated rates of most conditions being reported. However, this has been little studied taking a dimensional approach to autistic traits and in older age. METHODS A total of 20,220 adults aged 50-81 years from the PROTECT study reported whether they experienced persistent sociocommunicative traits characteristic of autism. Approximately 1%, 276 individuals, were identified as endorsing elevated autistic traits in childhood and currently, henceforth the "Autism Spectrum Trait" (AST) group. An age- and gender-matched comparison group was formed of 10,495 individuals who did not endorse any autistic behavioral traits, henceforth the "Control Older Adults" (COA) group. Differences between AST and COA groups were explored in self-reported psychiatric diagnoses, self-reported symptoms of current depression and anxiety, and self-reported physical health diagnoses. Associations were also examined between autistic traits and health across the whole sample. RESULTS The AST group reported significantly elevated rates of psychiatric diagnoses compared to the COA group. Additionally, the AST group showed significantly higher self-reported symptoms of current depression and anxiety than the COA group. However, few differences were observed in individual physical health conditions, and no differences in total co-occurring physical diagnoses between groups. Similar associations between autistic traits and health were also found taking a dimensional approach across the whole sample. DISCUSSION These findings suggest that older adults with elevated autistic traits may be at greater risk of poorer mental, but not physical, health in later life. Future studies should incorporate polygenic scores to elucidate the possible genetic links between the propensity to autism/high autistic traits and to psychiatric conditions, and to explore whether those with elevated autistic traits experience particular barriers to mental health care.
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Affiliation(s)
- Gavin R Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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29
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DaWalt LS, Taylor JL, Movaghar A, Hong J, Kim B, Brilliant M, Mailick MR. Health profiles of adults with autism spectrum disorder: Differences between women and men. Autism Res 2021; 14:1896-1904. [PMID: 34213066 PMCID: PMC8592037 DOI: 10.1002/aur.2563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/02/2021] [Accepted: 05/29/2021] [Indexed: 11/08/2022]
Abstract
The purpose of the present study was to investigate the hypothesis that women with autism have poorer health compared with men with autism, and compared with women without autism. Utilizing electronic health records drawn from a single health care system serving over 2 million individuals, 2119 adults with diagnosed autism spectrum disorders were compared with age- and sex-matched controls. When considering health care utilization, we found evidence of multiplicative risk for conditions within some domains (i.e., nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders) such that women with autism spectrum disorder (ASD) experienced double jeopardy-meaning they had greater rates of health care utilization within a domain than what would separately be expected by virtue of being a woman and having ASD. For other domains (i.e., endocrine disorders, gastrointestinal disorders), the risk was additive such that being a female and having ASD were both associated with higher health care utilization, but there were no significant interaction effects. It was only with respect to one domain (cardiovascular) that rates of health care utilization were reflective of neither ASD diagnosis nor sex. Overall, our findings suggest that women with ASD are a vulnerable subgroup with high levels of health care utilization. LAY SUMMARY: This study asked whether women with autism have poorer health compared with men with autism, and compared with women without autism. To answer this question, we used data from electronic health records. We found that women with autism spectrum disorder (ASD) were at the greatest risk for health problems such as nutrition conditions, neurologic disease, psychiatric conditions, and sleep disorders. More research on health of women with ASD is needed.
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Affiliation(s)
| | - Julie Lounds Taylor
- Vanderbilt University Medical Center, 407C VKC/One Magnolia Circle BLD, Nashville, TN
| | - Arezoo Movaghar
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Jinkuk Hong
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Bryan Kim
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Murray Brilliant
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Marsha R. Mailick
- University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
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30
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Warrilow A, Der G, Cooper SA, Minnis H, Pell JP. Childhood neurodevelopmental markers and risk of premature mortality: Follow-up to age 60-65 years in the Aberdeen Children of the 1950s study. PLoS One 2021; 16:e0255649. [PMID: 34407087 PMCID: PMC8372930 DOI: 10.1371/journal.pone.0255649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Individual neurodevelopmental disorders are associated with premature mortality. Little is known about the association between multiple neurodevelopmental markers and premature mortality at a population level. The ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) approach considers multiple neurodevelopmental parameters, assessing several markers in parallel that cluster, rather than considering individual diagnostic categories in isolation. Objectives To determine whether childhood neurodevelopmental markers, including reduced intellectual functioning, are associated with all-cause premature mortality. Methods and procedures In a general population cohort study (n = 12,150) with longitudinal follow up from childhood to middle age, Cox proportional hazard models were used to study the associations between childhood neurodevelopmental markers (Rutter B scale and IQ) and premature all-cause mortality. Outcomes and results The cognitive measures and 21 of the 26 Rutter B items were significantly associated with premature mortality in bivariate analyses with hazard ratios from 1.24 (95% CI 1.05–1.47) to 2.25 (95% CI 1.78–2.90). In the final adjusted model, neurodevelopmental markers suggestive of several domains including hyperactivity, conduct problems and intellectual impairment were positively associated with premature mortality and improved prediction of premature mortality. Conclusions A wide range of neurodevelopmental markers, including childhood IQ, were found to predict premature mortality in a large general population cohort with longitudinal follow up to 60–65 years of age. Implications These findings highlight the importance of a holistic assessment of children with neurodevelopmental markers that addresses a range of neurodevelopmental conditions. Our findings could open the door to a shift in child public mental health focus, where multiple and/or cumulative markers of neurodevelopmental conditions alert clinicians to the need for early intervention. This could lead to a reduction in the risk of broad health outcomes at a population level.
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Affiliation(s)
- Adele Warrilow
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Geoff Der
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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31
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Simantov T, Pohl A, Tsompanidis A, Weir E, Lombardo MV, Ruigrok A, Smith P, Allison C, Baron-Cohen S, Uzefovsky F. Medical symptoms and conditions in autistic women. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:373-388. [PMID: 34184558 PMCID: PMC8814970 DOI: 10.1177/13623613211022091] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The sex bias in autism diagnosis suggests the involvement of sex-specific endocrine mechanisms during prenatal development, but these hormones affect health throughout life. Therefore, the current study examined the association of autism and autistic traits with conditions and symptoms related to the sex-steroid system in adult women. In total, 1230 women (361 autistic), aged 15–77 years, reported on autistic traits and medical history. Medical diagnoses and symptoms were grouped by unsupervised factor analysis, and associations with autism diagnosis and autistic traits were explored. Higher rates of reproductive system diagnoses (odds ratio = 1.035, p = 0.024), prediabetes symptoms (odds ratio = 1.319, p = 0.001), irregular puberty onset (odds ratio = 1.458, p = 0.009), and menstrual length (odds ratio = 1.368, p = 0.034) and lower rates of metabolic and vascular conditions (odds ratio = 0.654, p = 0.013) were associated with diagnosis. Reproductive system diagnoses (β = 0.114, p = 0.000), prediabetes symptoms (β = 0.188, p = 0.000), menstrual length (β = 0.071, p = 0.014), irregular puberty onset (β = 0.149, p = 0.000), excessive menstruation symptoms (β = 0.097, p = 0.003), and hyperandrogenism symptoms (β = 0.062, p = 0.040) were also associated with autistic traits. Many of the conditions and symptoms found to be associated with autism or autistic traits are also related to conditions of steroid hormones and, specifically, the sex-steroid system. The study suggests an important role for steroids in autistic women, beyond prenatal development. Clinical implications are discussed.
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Geurts HM, McQuaid GA, Begeer S, Wallace GL. Self-reported parkinsonism features in older autistic adults: A descriptive study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:217-229. [PMID: 34154378 PMCID: PMC8750133 DOI: 10.1177/13623613211020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autistic adults without a suspected intellectual disability reported several motor features such as having tremors, and stiffness in one's legs which are considered to be part of a complex of motor features called parkinsonism. This so-called parkinsonism was remarkably prevalent in middle-aged and older autistic adults in two independent studies (Dutch study: 50-81 years, 183 males, 113 females, all adulthood diagnoses; the USA study: 50-83 years, 110 females, 109 males, majority adulthood diagnosis). Parkinsonism can be part of the progressive motor disease-Parkinson's disease. Therefore, it is important that future studies, including in-person neurological assessment, determine if (and if so, why) autistic adults who report these motor features are at increased risk for developing Parkinson's disease.
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Affiliation(s)
- Hilde M Geurts
- University of Amsterdam, The Netherlands.,Leo Kannerhuis (Youz/Parnassiagroup), The Netherlands
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Mason D, Ronald A, Ambler A, Caspi A, Houts R, Poulton R, Ramrakha S, Wertz J, Moffitt TE, Happé F. Autistic traits are associated with faster pace of aging: Evidence from the Dunedin study at age 45. Autism Res 2021; 14:1684-1694. [PMID: 34042279 DOI: 10.1002/aur.2534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 01/25/2023]
Abstract
Growing evidence indicates that the defining characteristics of autism spectrum disorder (ASD) are distributed throughout the general population; hence, understanding the correlates of aging in people with high autistic traits could shed light on ASD and aging. 915 members of the Dunedin longitudinal birth cohort completed a measure of autistic traits at age 45. A composite measure of the "pace of aging" was derived by tracking the decline in 19 biomarkers across ages 26, 32, 38, and 45 years. Facial age was also assessed. Reports of perceived health were collected from participants themselves, informants, and interviewers. Higher self-reported autistic traits significantly correlated with a faster pace of aging, older facial age, and poorer self-, informant-, and interviewer-rated health. After control for sex, SES and IQ, autistic traits were significantly associated with each variable: pace of aging (β = 0.09), facial age (β = 0.08), self- (β = -0.15), informant (β = -0.12), and interviewer-rated (β = -0.17) health. Autistic traits measured at age 45 are associated with faster aging. Participants with high autistic traits appear to be more vulnerable to poor health outcomes, as previously reported for those clinically diagnosed with ASD. Therefore, autistic traits may have important health implications. Replicating these findings in samples of autistic people is needed to identify the mechanism of their effect on aging and physical health to improve outcomes for those with ASD diagnoses or high autistic traits. LAY SUMMARY: The role that autistic traits have in relation to health outcomes has not been investigated. We looked at how physical health and aging (measured with self-reported questions and decline in multiple biological measures) were related to autistic traits (measured with a questionnaire, at age 45). We found that higher autistic traits were associated with poorer reports of physical health, and a faster pace of aging. This suggests that both those with autism and those with higher autistic traits may be more likely to experience poorer health outcomes.
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Affiliation(s)
- David Mason
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Angelica Ronald
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Antony Ambler
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA.,PROMENTA Center, University of Oslo, Oslo, Norway
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Jasmin Wertz
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Terrie E Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA.,PROMENTA Center, University of Oslo, Oslo, Norway
| | - Francesca Happé
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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Characteristics of Older Autistic Adults: a Systematic Review of Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00238-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1114-1124. [PMID: 33467914 PMCID: PMC8089036 DOI: 10.1177/1362361320982819] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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Affiliation(s)
- Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
| | | | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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Weir E, Allison C, Warrier V, Baron-Cohen S. Increased prevalence of non-communicable physical health conditions among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:681-694. [PMID: 32907337 PMCID: PMC7610707 DOI: 10.1177/1362361320953652] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
LAY ABSTRACT Previous research indicates autistic individuals die at a younger age than others and that this is possibly due in part to chronic physical health conditions. The present study used an anonymous, online survey to determine how common certain physical health conditions are among autistic adults, compared with non-autistic adults. We found autistic adults are more likely to develop heart conditions, lung conditions, and diabetes than non-autistic adults. Autistic females may be at higher risk of developing certain conditions (including respiratory conditions, asthma, and prediabetes) than autistic males. Finally, autistic individuals have increased health risks even when considering lifestyle factors (such as smoking, alcohol, and body mass index). This is still a relatively small study, and future research needs to confirm these findings and identify why these risks exist.
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Brice S, Rodgers J, Ingham B, Mason D, Wilson C, Freeston M, Le Couteur A, Parr JR. The importance and availability of adjustments to improve access for autistic adults who need mental and physical healthcare: findings from UK surveys. BMJ Open 2021; 11:e043336. [PMID: 33737429 PMCID: PMC7978247 DOI: 10.1136/bmjopen-2020-043336] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate autistic people's views on the importance and availability of adjustments to mental and physical healthcare provision. To explore whether specific categories of adjustments can be identified and to identify any differences in their importance and availability between mental and physical healthcare. DESIGN Data from two studies, both employing a cross-sectional survey design. SETTING UK-based autistic adults registered with the Adult Autism Spectrum Cohort-UK were contacted by post or online. In both studies, recruitment was staged over a 12-month period. Non-responders were sent a single reminder letter 2 weeks after initial contact. PARTICIPANTS 537 autistic adults completed a survey about mental health services (51% response rate), 407 completed the physical health survey (49% response rate). Within these samples, 221 participants completed both surveys. PRIMARY OUTCOME MEASURES Each study developed a bespoke survey to explore participants' views on mental and physical health services, respectively. Both included an identical list of adjustments that participants rated based on importance and availability. RESULTS Three factors of important adjustments were identified: sensory environment, clinical and service context, and clinician knowledge and communication. Adjustments across healthcare settings were widely rated as being important yet rarely available. One significant difference between the importance of adjustments available through mental and physical health services was identified. Participants reported that having access to a clinician who is willing to adapt their approach to suit the person's preferences was significantly more important for participants attending mental health settings (p=0.001). CONCLUSIONS Autistic people reported the limited availability of important adjustments in current healthcare provision. To address unmet need and tackle the health inequalities faced by autistic people attending physical and mental healthcare settings, healthcare providers should offer adjustments relating to the three identified factors. Future research should focus on identifying and addressing service provider barriers to implementation.
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Affiliation(s)
- Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Mason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Osei-Kuffour D, Dheansa B. The prevalence of autism spectrum disorder in the paediatric burns population. Burns 2021; 47:1220-1221. [PMID: 33824007 DOI: 10.1016/j.burns.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Denise Osei-Kuffour
- Department of Plastic Surgery, Burns Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, United Kingdom.
| | - Baljit Dheansa
- Department of Plastic Surgery, Burns Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, United Kingdom
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Vuattoux D, Colomer-Lahiguera S, Fernandez PA, Jequier Gygax M, Choucair ML, Beck-Popovic M, Diezi M, Manificat S, Latifyan S, Ramelet AS, Eicher M, Chabane N, Renella R. Cancer Care of Children, Adolescents and Adults With Autism Spectrum Disorders: Key Information and Strategies for Oncology Teams. Front Oncol 2021; 10:595734. [PMID: 33552969 PMCID: PMC7856416 DOI: 10.3389/fonc.2020.595734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Delivering optimal cancer care to children, adolescents and adults with ASD has recently become a healthcare priority and represents a major challenge for all providers involved. In this review, and after consideration of the available evidence, we concisely deliver key information on this heterogenous group of neurodevelopmental disorders, as well as recommendations and concrete tools for the enhanced oncological care of this vulnerable population of patients.
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Affiliation(s)
- Delphine Vuattoux
- Division of Autism Spectrum Disorders and Related Conditions, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Sara Colomer-Lahiguera
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre-Alain Fernandez
- Division of Autism Spectrum Disorders and Related Conditions, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marine Jequier Gygax
- Division of Autism Spectrum Disorders and Related Conditions, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Louise Choucair
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Diezi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland
| | - Sabine Manificat
- Division of Autism Spectrum Disorders and Related Conditions, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Sofiya Latifyan
- Division of Medical Oncology, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Chabane
- Division of Autism Spectrum Disorders and Related Conditions, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Raffaele Renella
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland
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Chien Y, Wu C, Tsai H. The Comorbidity of Schizophrenia Spectrum and Mood Disorders in Autism Spectrum Disorder. Autism Res 2020; 14:571-581. [DOI: 10.1002/aur.2451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Yi‐Ling Chien
- Department of Psychiatry National Taiwan University Hospital Taipei Taiwan
| | - Chi‐Shin Wu
- Department of Psychiatry National Taiwan University Hospital Taipei Taiwan
| | - Hui‐Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes Zhunan Taiwan
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Kassee C, Babinski S, Tint A, Lunsky Y, Brown HK, Ameis SH, Szatmari P, Lai MC, Einstein G. Physical health of autistic girls and women: a scoping review. Mol Autism 2020; 11:84. [PMID: 33109257 PMCID: PMC7590704 DOI: 10.1186/s13229-020-00380-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is a growing recognition of sex and gender influences in autism. Increasingly, studies include comparisons between sexes or genders, but few have focused on clarifying the characteristics of autistic girls'/women's physical health. METHODS A scoping review was conducted to determine what is currently known about the physical health of autistic girls/women. We screened 1112 unique articles, with 40 studies meeting the inclusion criteria. We used a convergent iterative process to synthesize this content into broad thematic areas. RESULTS Autistic girls/women experience more overall physical health challenges compared to non-autistic girls/women and to autistic boys/men. Emerging evidence suggests increased prevalence of epilepsy in autistic girls/women compared to non-autistic girls/women and to autistic boys/men. The literature also suggests increased endocrine and reproductive health conditions in autistic girls/women compared to non-autistic girls/women. Findings regarding gastrointestinal, metabolic, nutritional, and immune-related conditions are preliminary and inconsistent. LIMITATIONS The literature has substantial heterogeneity in how physical health conditions were assessed and reported. Further, our explicit focus on physical health may have constrained the ability to examine interactions between mental and physical health. The widely differing research aims and methodologies make it difficult to reach definitive conclusions. Nevertheless, in keeping with the goals of a scoping review, we were able to identify key themes to guide future research. CONCLUSIONS The emerging literature suggests that autistic girls/women have heightened rates of physical health challenges compared to non-autistic girls/women and to autistic boys/men. Clinicians should seek to provide holistic care that includes a focus on physical health and develop a women's health lens when providing clinical care to autistic girls/women.
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Affiliation(s)
- Caroline Kassee
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephanie Babinski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Sociology, University of Toronto, Toronto, Canada
| | - Ami Tint
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Stephanie H Ameis
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Peter Szatmari
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada.
- Department of Psychology, University of Toronto, Toronto, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - Gillian Einstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Rotman Research Institute, Baycrest Hospital, Toronto, Canada
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Smith GS, Fleming M, Kinnear D, Henderson A, Pell JP, Melville C, Cooper SA. Mortality in 787,666 school pupils with and without autism: A cohort study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:300-304. [PMID: 32830516 PMCID: PMC7812511 DOI: 10.1177/1362361320944037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies on children and adults combined suggest higher mortality rates for autistic than other people, but few report mortality rates for autistic children. In addition, past studies may not be representative of the current generation of children diagnosed with autism. We examined mortality in children using data from Scotland’s annual pupil census, linked to National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) of 787,666 pupils had autism. They were more likely to live in neighbourhoods of greater deprivation and receive free school meals. Six autistic pupils died; crude mortality rate 15.8/100,000 person-years (95% CI = 7.1–35.1), compared with 458 other pupils; crude mortality rate 12.5/100,000 person-years (95% CI = 11.4–13.7). The indirectly standardised mortality ratio was 1.1 (95% CI = 0.5–2.5). In the autistic pupils, the most common causes of death were nervous system diseases, for example, epilepsy. Avoidable causes were common. In the comparison group, external causes and cancers were the most common causes of death. We cautiously conclude that mortality in the current generation of autistic children is no higher than for other children, perhaps due to recent widening of criteria for autism spectrum diagnosis, but some deaths could have been avoided by better care.
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Crompton CJ, Hallett S, Ropar D, Flynn E, Fletcher-Watson S. 'I never realised everybody felt as happy as I do when I am around autistic people': A thematic analysis of autistic adults' relationships with autistic and neurotypical friends and family. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1438-1448. [PMID: 32148068 PMCID: PMC7376620 DOI: 10.1177/1362361320908976] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
LAY ABSTRACT Although autistic people may struggle to interact with others, many autistic people have said they find interacting with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We analysed the interviews and found three common themes in what our participants said. First, they found spending with other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves around them. These findings show that having time with autistic friends and family can be very beneficial for autistic people and played an important role in a happy social life.
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Stringer D, Kent R, Briskman J, Lukito S, Charman T, Baird G, Lord C, Pickles A, Simonoff E. Trajectories of emotional and behavioral problems from childhood to early adult life. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1011-1024. [PMID: 32191121 PMCID: PMC7521012 DOI: 10.1177/1362361320908972] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
LAY ABSTRACT Although mental health problems are common in autism, relatively little is known about their stability and the factors that influence their persistence or change over the life-course. To address this, we use data from the Special Needs and Autism Project (SNAP) cohort studied at three time-points from 12 to 23 years. Using the parent-reported Strengths and Difficulties Questionnaire (SDQ) domains of conduct, emotional, and ADHD symptoms, we evaluated the role of child, family, and contextual characteristics on these three trajectories. Symptoms decreased significantly over time for all three domains, but many participants still scored above the published disorder cutoffs. Individuals showed high levels of persistence. Higher initial adaptive function and language levels predicted a greater decline in conduct and ADHD symptoms. In contrast, higher language functioning was associated with higher levels of emotional symptoms, as was lower levels of autism symptom severity and higher parental education. Those with higher neighborhood deprivation had higher initial conduct problems but a steeper decline over time. Our findings highlight that it may be possible to accurately predict mental health trajectories over this time period, which could help parents and carers in planning and help professionals target resources more efficiently.
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Affiliation(s)
| | | | | | | | | | | | - Catherine Lord
- UCLA Semel Institute for Neuroscience
and Human Behavior, USA
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45
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Leibson C, Weaver A, Myers S, Long K, Ransom J, Voigt R, Katusic S. Objective Estimates of Direct-Medical Costs Among Persons Aged 3 to 38 Years With and Without Research-Defined Autism Spectrum Disorder Ascertained During Childhood: A Population-Based Birth-Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:595-605. [PMID: 32389225 PMCID: PMC7224581 DOI: 10.1016/j.jval.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/25/2019] [Accepted: 12/22/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Accurate estimates of autism spectrum disorder (ASD)-associated medical costs are essential for predicting future care needs, allocating resources, identifying best practices, and modeling cost-effectiveness. Most existing studies have either employed subjective cost data or ascertained ASD using self-reported or International Classification of Diseases-coded diagnoses. Such ascertainment is especially problematic for identifying milder ASD among older individuals never diagnosed with ASD. METHODS This 1976 through 2000 population-based birth-cohort study was set in Olmsted County, Minnesota. ASD cases and age- and sex-matched unaffected controls were identified by applying uniform operational research criteria for ASD (using the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision) after rigorous review of provider-linked medical and public, private, or home school records available for all members from birth to a maximum age of 21 years. Medical cost estimates for the 901 case-control pairs used line-item provider-linked billing data (including all payers) from 2003 through 2014 (ages 3-38 years). Outpatient pharmaceutical costs were unavailable. Temporal changes in diagnostic criteria, clinical practice, public awareness, and access were addressed by separating analyses into 5-year age group and 4-year calendar period cells. Unadjusted and adjusted (age and age plus co-occurring conditions) cost estimates were provided for cases, controls, and case-control differences. Additional factors (co-occurring conditions, percentage hospitalized, intellectual disability) were investigated using unadjusted descriptive analyses. RESULTS Cell sample sizes ranged from 93 to 402 for age groups 3 through 19 years and from 45 to 395 for age groups 20 through 38 years. Unadjusted, age-adjusted, and fully adjusted medical costs were significantly higher for cases versus controls in 100% of cells for age groups 3 through 19 years and in 50% (unadjusted), 38% (age adjusted), and 12% (fully adjusted) of cells for age groups 20 through 38 years. CONCLUSIONS These unique estimates can help inform the construction of cost-effectiveness models; decisions by payers, providers, and policy makers; and predictions of lifetime costs.
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Affiliation(s)
- Cynthia Leibson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.
| | - Amy Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Scott Myers
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - Kirsten Long
- K Long Health Economics Consulting LLC, St Paul, MN, USA
| | - Jeanine Ransom
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Robert Voigt
- Meyer Center for Developmental Pediatrics, Baylor College, of Medicine, Houston, TX, USA
| | - Slavica Katusic
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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Dunn K, Rydzewska E, Fleming M, Cooper SA. Prevalence of mental health conditions, sensory impairments and physical disability in people with co-occurring intellectual disabilities and autism compared with other people: a cross-sectional total population study in Scotland. BMJ Open 2020; 10:e035280. [PMID: 32341043 PMCID: PMC7204861 DOI: 10.1136/bmjopen-2019-035280] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To investigate prevalence of mental health conditions, sensory impairments and physical disability in children, adults and older adults with co-occurring intellectual disabilities and autism, given its frequent co-occurrence, compared with the general population. DESIGN Whole country cohort study. SETTING General community. PARTICIPANTS 5709 people with co-occurring intellectual disabilities and autism, compared with 5 289 694 other people. OUTCOME MEASURES Rates and ORs with 95% CIs for mental health conditions, visual impairment, hearing impairment and physical disability in people with co-occurring intellectual disabilities and autism compared with other people, adjusted for age, sex and interaction between age and co-occurring intellectual disabilities and autism. RESULTS All four long-term conditions were markedly more common in children, adults and older adults with co-occurring intellectual disabilities and autism compared with other people. For mental health, OR=130.8 (95% CI 117.1 to 146.1); visual impairment OR=65.9 (95% CI 58.7 to 73.9); hearing impairment OR=22.0 (95% CI 19.2 to 25.2); and physical disability OR=157.5 (95% CI 144.6 to 171.7). These ratios are also greater than previously reported for people with either intellectual disabilities or autism rather than co-occurring intellectual disabilities and autism. CONCLUSIONS We have quantified the more than double disadvantage for people with co-occurring intellectual disabilities and autism, in terms of additional long-term health conditions. This may well impact on quality of life. It raises challenges for staff working with these people in view of additional complexity in assessments, diagnoses and interventions of additional health conditions, as sensory impairments and mental health conditions in particular, compound with the persons pre-existing communication and cognitive problems in this context. Planning is important, with staff being trained, equipped, resourced and prepared to address the challenge of working for people with these conditions.
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Affiliation(s)
- Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Ewelina Rydzewska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Michael Fleming
- Department of Public Health, University of Glasgow, Glasgow, Scotland, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Strydom A, Bosco A, Vickerstaff V, Hunter R, Hassiotis A. Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial. BMC Psychiatry 2020; 20:161. [PMID: 32293383 PMCID: PMC7158144 DOI: 10.1186/s12888-020-02577-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. METHODS The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. RESULTS There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = - 2.10, 95% CI: - 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI - 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. CONCLUSIONS Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. TRIAL REGISTRATION ClinicalTrials.gov: NCT01680276.
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Affiliation(s)
- Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. .,Division of Psychiatry, University College London, London, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Alessandro Bosco
- grid.4563.40000 0004 1936 8868Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Victoria Vickerstaff
- grid.13097.3c0000 0001 2322 6764Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Rachael Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Angela Hassiotis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK ,grid.451052.70000 0004 0581 2008Camden & Islington Foundation NHS Trust, London, UK
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Crompton CJ, Michael C, Fletcher-Watson S. Co-Creating the Autistic Satisfaction with Care Holistic Interview to Examine the Experiences of Older Autistic Adults in Residential Care. AUTISM IN ADULTHOOD 2020. [DOI: 10.1089/aut.2019.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Catherine J. Crompton
- Division of Psychiatry, Patrick Wild Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Cos Michael
- Independent Autistic Consultant, United Kingdom
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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Casanova MF, Frye RE, Gillberg C, Casanova EL. Editorial: Comorbidity and Autism Spectrum Disorder. Front Psychiatry 2020; 11:617395. [PMID: 33329163 PMCID: PMC7714785 DOI: 10.3389/fpsyt.2020.617395] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Manuel F Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
| | | | | | - Emily L Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
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A public health approach to reducing health inequalities among adults with autism. Br J Gen Pract 2019; 69:534-535. [PMID: 31672799 DOI: 10.3399/bjgp19x706133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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