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Hersh L, Dwyer P, Kapp SK, Shevchuk-Hill S, Gurba AN, Kilgallon E, Mair APA, Chang DS, Rivera SM, Gillespie-Lynch K. Community Member Views on Autism Intervention: Effects of Closeness to Autistic People with Intellectual Disabilities And Nonspeaking Autistic People. AUTISM IN ADULTHOOD 2024; 6:253-271. [PMID: 39371356 PMCID: PMC11447397 DOI: 10.1089/aut.2023.0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Background Controversy regarding the neurodiversity movement (NDM), the social and medical models of disability, autism intervention goals, and causal attributions of disability contributes to divides in the autistic and autism communities. The present study investigates the views of autistic and non-autistic autistic and autism community members on these topics. We explored whether these views are shaped by having close relationships to autistic people with intellectual disabilities (ID) and nonspeaking autistic (NSA) people. Methods A total of 504 autistic and autism community members (278 autistic, 226 non-autistic) completed an online survey about theoretical models and intervention goals. Participants reported whether they had one or more close relationships with NSA people, autistic people with ID, neither, or both. Results Overall, there was considerable consensus regarding desired intervention goals: normalization goals were generally opposed, while participants generally supported well-being, societal reform, supportive environment, and adaptive skill goals. While autistic participants reported less support for normalization and adaptive skills goals than non-autistic participants, they expressed somewhat more enthusiasm for societal reform and supportive environments than non-autistic people. Autistic people supported the NDM more and the medical model less than non-autistic people. Those close to autistic people with ID gave higher ratings to adaptive skill goals. On average, participants not close to autistic people with ID saw the challenges of those without ID as being slightly more due to environmental/social factors than the challenges of those with ID; there was no such statistical difference among those close to autistic people with ID. Conclusion Further research investigating community views, with the inclusion of more autistic people with ID and NSA people themselves, is needed, but the results of this study suggest that the broader autistic and autism communities see NDM-consistent intervention goals as appropriate for all autistic people, including NSA people and those with ID. As autism interventions have often pursued unpopular normalization goals, this suggests directions for reform.
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Affiliation(s)
- Lynnette Hersh
- Department of Psychology, University of California, Davis, California, USA
- Center for Mind and Brain, University of California, Davis, California, USA
- California School of Professional Psychology, Alliant International University, San Francisco, California, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, California, USA
- Center for Mind and Brain, University of California, Davis, California, USA
- MIND Institute, University of California, Davis, California, USA
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Steven K. Kapp
- Centre for Interaction, Development and Diversity, University of Portsmouth, Portsmouth, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | | | - Ava N. Gurba
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth Kilgallon
- Yale Child Study Center, Yale University, New Haven, Connecticut, USA
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | | | - David S. Chang
- Department of Psychology, University of California, Davis, California, USA
- Center for Mind and Brain, University of California, Davis, California, USA
| | - Susan M. Rivera
- Department of Psychology, University of California, Davis, California, USA
- Center for Mind and Brain, University of California, Davis, California, USA
- MIND Institute, University of California, Davis, California, USA
- Department of Psychology, University of Maryland College Park, College Park, Maryland, USA
| | - Kristen Gillespie-Lynch
- College of Staten Island, City University of New York, New York, New York, USA
- The Graduate Center, City University of New York, New York, New York, USA
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Eccles JA, Quadt L, Garfinkel SN, Critchley HD. A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230247. [PMID: 39005028 PMCID: PMC11444222 DOI: 10.1098/rstb.2023.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/04/2024] [Indexed: 07/16/2024] Open
Abstract
Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.
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Affiliation(s)
- Jessica A Eccles
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
| | - Lisa Quadt
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
| | - Sarah N Garfinkel
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, UK
| | - Hugo D Critchley
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
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O'Nions E, Brown J, Buckman JE, Charlton R, Cooper C, El Baou C, Happé F, Hoare S, Lewer D, Manthorpe J, McKechnie DG, Richards M, Saunders R, Mandy W, Stott J. Diagnosis of common health conditions among autistic adults in the UK: evidence from a matched cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100907. [PMID: 39119101 PMCID: PMC11306212 DOI: 10.1016/j.lanepe.2024.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 08/10/2024]
Abstract
Background Autistic people are disproportionately likely to experience premature mortality and most mental and physical health conditions. We measured the incidence of diagnosed conditions accounting for the most disability-adjusted life years in the UK population according to the Global Burden of Disease study (anxiety, depression, self-harm, harmful alcohol use, substance use, migraine, neck or back pain, and gynaecological conditions). Methods Participants were aged 18 years or above and had an autism diagnosis recorded in the IQVIA Medical Research Database between 01/01/2000 and 16/01/2019. We included 15,675 autistic adults without intellectual disability, 6437 autistic adults with intellectual disability, and a comparison group matched (1:10) by age, sex, and primary care practice. We estimated crude incidences and incidence rate ratios (IRRs) adjusted for age and sex. Findings Autistic adults without intellectual disability experienced a higher incidence (IRR, 95% CI) of self-harm (2.07, 1.79-2.40), anxiety (1.91, 1.76-2.06), depressive disorders (1.79, 1.67-1.92), and substance use (1.24, 1.02-1.51) relative to comparison participants. Incidences of harmful alcohol use (1.01, 0.85-1.18), migraine (0.99, 0.84-1.17), and gynaecological conditions (1.19, 0.95-1.49) did not differ. Neck or back pain incidence was lower (0.88, 0.82-0.95). Autistic adults with intellectual disability experienced a higher incidence of self-harm (2.08, 1.69-2.56). Incidences of anxiety (1.14, 1.00-1.30), gynaecological conditions (1.22, 0.93-1.62), and substance use (1.08, 0.80-1.47) did not differ, and lower incidences were found for depressive disorders (0.73, 0.64-0.83), harmful alcohol use (0.65, 0.50-0.84), migraine (0.55, 0.42-0.74), and neck or back pain (0.49, 0.44-0.55). Interpretation Although our findings cannot be directly compared to previous prevalence studies, they contrast with the higher frequency of mental and physical health conditions in autistic adults reported in studies that directly assessed and/or surveyed autistic people about co-occurring conditions. The present findings may suggest under-diagnosis of common conditions in autistic people, particularly those with intellectual disability. Improved detection should be a clinical and policy priority to reduce health inequalities. Funding Dunhill Medical Trust, Economic and Social Research Council, National Institute of Health and Care Research.
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Affiliation(s)
- Elizabeth O'Nions
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Jude Brown
- National Autistic Society, 391-393 City Rd, London, EC1V 1NG, UK
| | - Joshua E.J. Buckman
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths, University of London, New Cross, London, SE14 6NW, UK
| | - Claudia Cooper
- Queen Mary, University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK
| | - Céline El Baou
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Sarah Hoare
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Dan Lewer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, Strand, London, WC2R 2LS, UK
| | - Douglas G.J. McKechnie
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rob Saunders
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Will Mandy
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Joshua Stott
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, 1 – 19 Torrington Place, London, WC1E 7HB, UK
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