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Charpentier CJ, Wu Q, Min S, Ding W, Cockburn J, O'Doherty JP. Heterogeneity in strategy use during arbitration between experiential and observational learning. Nat Commun 2024; 15:4436. [PMID: 38789415 PMCID: PMC11126711 DOI: 10.1038/s41467-024-48548-y] [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: 04/14/2023] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
To navigate our complex social world, it is crucial to deploy multiple learning strategies, such as learning from directly experiencing action outcomes or from observing other people's behavior. Despite the prevalence of experiential and observational learning in humans and other social animals, it remains unclear how people favor one strategy over the other depending on the environment, and how individuals vary in their strategy use. Here, we describe an arbitration mechanism in which the prediction errors associated with each learning strategy influence their weight over behavior. We designed an online behavioral task to test our computational model, and found that while a substantial proportion of participants relied on the proposed arbitration mechanism, there was some meaningful heterogeneity in how people solved this task. Four other groups were identified: those who used a fixed mixture between the two strategies, those who relied on a single strategy and non-learners with irrelevant strategies. Furthermore, groups were found to differ on key behavioral signatures, and on transdiagnostic symptom dimensions, in particular autism traits and anxiety. Together, these results demonstrate how large heterogeneous datasets and computational methods can be leveraged to better characterize individual differences.
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Affiliation(s)
- Caroline J Charpentier
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
- Department of Psychology & Brain and Behavior Institute, University of Maryland, College Park, MD, USA.
| | - Qianying Wu
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Seokyoung Min
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Weilun Ding
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Jeffrey Cockburn
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - John P O'Doherty
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
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Leroy G, Andrews JG, KeAlohi-Preece M, Jaswani A, Song H, Galindo MK, Rice SA. Transparent deep learning to identify autism spectrum disorders (ASD) in EHR using clinical notes. J Am Med Inform Assoc 2024; 31:1313-1321. [PMID: 38626184 PMCID: PMC11105145 DOI: 10.1093/jamia/ocae080] [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: 11/02/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE Machine learning (ML) is increasingly employed to diagnose medical conditions, with algorithms trained to assign a single label using a black-box approach. We created an ML approach using deep learning that generates outcomes that are transparent and in line with clinical, diagnostic rules. We demonstrate our approach for autism spectrum disorders (ASD), a neurodevelopmental condition with increasing prevalence. METHODS We use unstructured data from the Centers for Disease Control and Prevention (CDC) surveillance records labeled by a CDC-trained clinician with ASD A1-3 and B1-4 criterion labels per sentence and with ASD cases labels per record using Diagnostic and Statistical Manual of Mental Disorders (DSM5) rules. One rule-based and three deep ML algorithms and six ensembles were compared and evaluated using a test set with 6773 sentences (N = 35 cases) set aside in advance. Criterion and case labeling were evaluated for each ML algorithm and ensemble. Case labeling outcomes were compared also with seven traditional tests. RESULTS Performance for criterion labeling was highest for the hybrid BiLSTM ML model. The best case labeling was achieved by an ensemble of two BiLSTM ML models using a majority vote. It achieved 100% precision (or PPV), 83% recall (or sensitivity), 100% specificity, 91% accuracy, and 0.91 F-measure. A comparison with existing diagnostic tests shows that our best ensemble was more accurate overall. CONCLUSIONS Transparent ML is achievable even with small datasets. By focusing on intermediate steps, deep ML can provide transparent decisions. By leveraging data redundancies, ML errors at the intermediate level have a low impact on final outcomes.
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Affiliation(s)
- Gondy Leroy
- Department of Management Information Systems, The University of Arizona, Tucson, AZ 85621, United States
| | - Jennifer G Andrews
- Department of Pediatrics, The University of Arizona, Tucson, AZ 85621, United States
| | | | - Ajay Jaswani
- Department of Management Information Systems, The University of Arizona, Tucson, AZ 85621, United States
| | - Hyunju Song
- Department of Computer Science, The University of Arizona, Tucson, AZ 85621, United States
| | - Maureen Kelly Galindo
- Department of Pediatrics, The University of Arizona, Tucson, AZ 85621, United States
| | - Sydney A Rice
- Department of Pediatrics, The University of Arizona, Tucson, AZ 85621, United States
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McKernan EP, Russo N. Investigating the Structure of the CESD-R and DASS-21 Across Adults with Low and High Levels of Autistic Traits. J Autism Dev Disord 2024; 54:2026-2039. [PMID: 36959520 DOI: 10.1007/s10803-023-05944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
The current study examined factorial invariance of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Depression Anxiety Stress Scales-21 (DASS-21) using a convenience sample of 434 adults surveyed though Amazon Mechanical Turk. Participants were sorted into two groups based on their score on the Autism-Spectrum Quotient. Results indicated that the CESD-R did not demonstrate configural invariance. The DASS-21 demonstrated evidence of scalar invariance, indicating cross-group equality in factor loadings and factor intercepts. Findings suggest that the DASS-21 measures symptoms of depression, anxiety, and stress consistently across individuals with high and low levels of ASD-related traits, whereas the CESD-R may not be valid when assessing symptoms of depression in those with a high level of ASD-related traits.
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Affiliation(s)
- Elizabeth P McKernan
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie Russo
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
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Pugliese CE, Handsman R, You X, Anthony LG, Vaidya C, Kenworthy L. Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241246091. [PMID: 38642028 DOI: 10.1177/13623613241246091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
LAY ABSTRACT Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.
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Woodhouse E, Hollingdale J, Davies L, Al-Attar Z, Young S, Vinter LP, Agyemang K, Bartlett C, Berryessa C, Chaplin E, Deeley Q, Freckelton I, Gerry F, Gudjonsson G, Maras K, Mattison M, McCarthy J, Mills R, Misch P, Murphy D, Allely C. Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience. BMC Med 2024; 22:157. [PMID: 38609939 PMCID: PMC11015650 DOI: 10.1186/s12916-024-03320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION Greater attention needs to be given to this population as they navigate the CJS.
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Affiliation(s)
- Emma Woodhouse
- Compass Psychology Services Ltd, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Zainab Al-Attar
- University of Oxford, London, UK
- University College London, London, UK
- Victoria University, Melbourne, Australia
- University of Central Lancashire, Preston, UK
| | - Susan Young
- Psychology Services Limited, London, UK
- University of Reykjavík, Reykjavík, Iceland
| | - Luke P Vinter
- Department of Criminology, University of Derby, Derby, UK
| | | | | | | | - Eddie Chaplin
- London South Bank University, Institute of Health and Social Care, London, UK
| | - Quinton Deeley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Autism Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Freckelton
- Law Faculty and Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Castan Chambers, Melbourne, Australia
| | - Felicity Gerry
- Libertas Chambers, London, UK
- Crockett Chambers, Melbourne, Australia
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Auckland, Auckland, New Zealand
| | - Richard Mills
- AT-Autism, London, UK
- Department of Psychology, University of Bath, Bath, UK
| | | | - David Murphy
- Broadmoor Hospital, West London NHS Trust, London, UK
| | - Clare Allely
- School of Health and Society, University of Salford, Manchester, UK.
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Dell'Osso L, Amatori G, Giovannoni F, Massimetti E, Cremone IM, Carpita B. Rumination and altered reactivity to sensory input as vulnerability factors for developing post-traumatic stress symptoms among adults with autistic traits. CNS Spectr 2024; 29:119-125. [PMID: 38224059 DOI: 10.1017/s1092852924000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Recent literature has suggested that individuals with autism spectrum disorder (ASD) or autistic traits (ATs) would be more likely to encounter traumatic events in their lifetime and to develop post-traumatic stress disorder (PTSD). However, the nature of this relationship has not yet been fully elucidated. The aims of this study were to evaluate the relationship between AT and PTSD and to investigate which specific autistic dimension was more associated with trauma and stress-related symptoms. METHODS A total of 68 subjects with ASD and 64 healthy controls (HCs) were assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Trauma and Loss Spectrum (TALS) questionnaires. Statistical analyses included Mann-Whitney U test, chi-square test, calculation of Spearman's coefficients, and logistic regression analysis. RESULTS Patients with significant AT reported a 30% rate of PTSD and higher TALS total and domain scores than HCs, among whom no PTSD was found instead. Significant positive correlations were reported between AdAS Spectrum and TALS-SR scores in the whole sample. AdAS Spectrum total scores were statistically predictive of the presence of PTSD. High scores at AdAS Spectrum Inflexibility and adherence to routine and Restrictive interest and rumination domains were identified as positive predictors of a probable PTSD. CONCLUSION Compared to HCs, subjects with significant AT are more likely to present symptoms of PTSD. In particular, AT related to ruminative thinking, narrow interests, and sensorial reactivity would seem to predict the presence of post-traumatic stress symptomatology.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Giovannoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Moschogianis S, Darley S, Coulson T, Peek N, Cheraghi-Sohi S, Brown BC. Patient experiences of an online consultation system: a qualitative study in English primary care post-COVID-19. Br J Gen Pract 2024:BJGP.2023.0076. [PMID: 38164550 PMCID: PMC10966478 DOI: 10.3399/bjgp.2023.0076] [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] [Received: 02/16/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Online consultation systems (OCSs) allow patients to contact their healthcare teams online. Since 2020 they have been rapidly rolled out in primary care following policy initiatives and the COVID-19 pandemic. In-depth research of patients' experiences using OCSs is lacking. AIM Explore patients' experiences of using an OCS. DESIGN AND SETTING Qualitative study in English GP practices using the Patchs OCS (www.Patchs.ai) from March 2020 to July 2022. METHOD Thematic analysis of 25 patient interviews and 21 467 written comments from 11 851 patients who used the OCS from nine and 240 GP practices, respectively. RESULTS Patients cited benefits of using the OCS as speed, flexibility, and efficiency. Nevertheless, some patients desired a return to traditional consultation methods. GP practices often did not clearly advertise the OCS or use it as patients expected, which caused frustration. Patients reported advantages of having a written record of consultations and the opportunity to communicate detailed queries in free text. Views differed on how the OCS influenced clinical safety and discussions of sensitive topics. Patients who struggled to communicate in traditional consultations often preferred using the OCS, and male patients reported being more likely to use it. CONCLUSION Globally, this is the largest in-depth study of patient experiences of an OCS. It contributes new knowledge that the patient experience of using OCSs can be influenced by previously unreported patient characteristics and the conditions they consult about. Further, it contributes recommendations on the design and implementation of the OCS in practice.
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Affiliation(s)
- Susan Moschogianis
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester
| | - Sarah Darley
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester
| | | | - Niels Peek
- Imaging and Data Science, University of Manchester, Manchester Academic Health Science Centre, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Sudeh Cheraghi-Sohi
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Benjamin C Brown
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester; and chief medical officer, Patchs Health, London
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Huang Y, Arnold SRC, Foley KR, Trollor JN. Experiences of Support Following Autism Diagnosis in Adulthood. J Autism Dev Disord 2024; 54:518-531. [PMID: 36409392 DOI: 10.1007/s10803-022-05811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/22/2022]
Abstract
This study aimed to explore experiences of support after adulthood autism diagnosis. In this mixed-methods survey study of 137 adults, we found that most common formal supports received were counselling and mental health. Common unmet support needs were sensory sensitivities and accessing other services. Cost, lack of information, and fear of not being taken seriously were common barriers. Informal support was mainly helpful for self-understanding and emotions toward diagnosis. Qualitative findings included difficulties accessing formal support, need for practical quality-of-life supports and support from autistic peers and online communities. Based on these findings, future development of supportive interventions should address unmet needs, improve access, and explore the integration of autistic peer support and online support into formal services.
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Affiliation(s)
- Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, NSW, 2052, Australia
- The Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, QLD, Australia
| | - Samuel R C Arnold
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, NSW, 2052, Australia.
- The Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, QLD, Australia.
| | - Kitty-Rose Foley
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, NSW, 2052, Australia
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, NSW, 2052, Australia
- The Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, QLD, Australia
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Lage C, Smith ES, Lawson RP. A meta-analysis of cognitive flexibility in autism spectrum disorder. Neurosci Biobehav Rev 2024; 157:105511. [PMID: 38104788 DOI: 10.1016/j.neubiorev.2023.105511] [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: 09/06/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Cognitive flexibility is a fundamental process that underlies adaptive behaviour in response to environmental change. Studies examining the profile of cognitive flexibility in autism spectrum disorder (ASD) have reported inconsistent findings. To address whether difficulties with cognitive flexibility are characteristic of autism, we conducted a random-effects meta-analysis and employed subgroup analyses and meta-regression to assess the impact of relevant moderator variables such as task, outcomes, and age. Fifty-nine studies were included and comprised of 2122 autistic individuals without intellectual disabilities and 2036 neurotypical controls, with an age range of 4 to 85 years. The results showed that autistic individuals have greater difficulties with cognitive flexibility, with an overall statistically significant small to moderate effect size. Subgroup analyses revealed a significant difference between task outcomes, with perseverative errors obtaining the largest effect size. In summary, the present meta-analysis highlights the existence of cognitive flexibility difficulties in autistic people, in the absence of learning disabilities, but also that this profile is characterised by substantial heterogeneity. Potential contributing factors are discussed.
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Affiliation(s)
- Claudia Lage
- Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, United Kingdom.
| | - Eleanor S Smith
- Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, United Kingdom
| | - Rebecca P Lawson
- Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, United Kingdom
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Hsu JW, Chen LC, Huang KL, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH. The influence of sex on major psychiatric comorbidities and parental psychiatric disorders in 22,698 children and adolescents with ICD-9-CM-based autism spectrum disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:19-25. [PMID: 36459229 DOI: 10.1007/s00406-022-01529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
It remains unclear how major psychiatric comorbidities and parental psychiatric disorders differ in males and females with autism spectrum disorder (ASD). Between 2001 and 2011, 17,627 children and 5071 adolescents with ASD (ICD-9-CM code: 299) were identified from Taiwan's National Health Insurance Research Database and assessed for major psychiatric comorbidities and parental psychiatric disorders. Compared with females with ASD, males with ASD were more likely to be diagnosed as having attention deficit hyperactivity disorder (relative risk [RR], 95% confidence interval [CI] 1.63, 1.51-1.75) and disruptive behavior disorder (1.38, 1.17-1.62) and less likely to be diagnosed as having schizophrenia (0.45, 0.36-0.56), bipolar disorder (0.58, 0.45-0.74), or intellectual disability (0.53, 0.49-0.58). Furthermore, compared with women, having a parental history of schizophrenia (RR, 95% CI 0.66, 0.49-0.89) or intellectual disability (0.34, 0.19-0.61) was less associated with ASD among men. However, the difference in ASD diagnosis between ICD-9-CM and ICD-10/11-CM systems may reflect the different, but surely overlapping, entity of ASD, which may limit the generalization of our results. Additional studies should be performed.
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Affiliation(s)
- Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Chi Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Xinzhu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
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Petty S, Allen S, Pickup H, Woodier B. A Blog-Based Study of Autistic Adults' Experiences of Aloneness and Connection and the Interplay with Well-Being: Corpus-Based and Thematic Analyses. AUTISM IN ADULTHOOD 2023; 5:437-449. [PMID: 38116056 PMCID: PMC10726169 DOI: 10.1089/aut.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background Autistic adults appear to be more vulnerable to mental ill health, with loneliness being a variable associated with multiple outcomes of poorer well-being. However, a description of meaningful social connection that is suitable for autistic adults is missing from this research, along with a missing understanding of the conditions that contribute to well-being. Methods In this study, autistic adults' experiences of connectedness and aloneness were systematically searched for within data collected from blogs. This contributed a creative method to hear the viewpoint of autistic adults. Corpus-based and thematic analyses explored the descriptions and contexts of relationships. A total of 16 autistic authors contributed views. Results Social connection was desired and was achieved through self-acceptance and rejecting deficit-based views of being autistic, and selectively choosing important relationships. Meaningful social connection changed over time, being more difficult to attain in childhood, and benefiting from self-learning and effortfully applying neuro-normative skills in social communication. Loneliness was only described alongside other causes of unhappiness and was not associated with being autistic. Conclusions The findings offer some explanation for the high estimates of both loneliness and mental ill health for autistic adults. We consider the implications for autistic individuals, clinicians, educators, and researchers. We are also cautious not to imply that these views reflect all autistic people. The findings suggest that improvements are needed in society to share communication differences and relationship expectations for autistic individuals to be accepted and valued.
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Affiliation(s)
- Stephanie Petty
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Shannon Allen
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Hannah Pickup
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Bethannie Woodier
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
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Chisholm K, Schirmbeck F, Pinkham AE, Sasson NJ, Simons CJP, de Haan L, Harvey PD, Penn DL, Ziermans T. A Cross-sectional Conceptual Replication and Longitudinal Evaluation of the PANSS-Autism-Severity-Score Measure Suggests it Does Not Capture Autistic Traits in Individuals With Psychosis. Schizophr Bull 2023:sbad161. [PMID: 37992238 DOI: 10.1093/schbul/sbad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Autism and psychosis co-occur at elevated rates, with implications for clinical outcomes, functioning, and suicidality. The PANSS-Autism-Severity-Score (PAUSS) is a measure of autism trait severity which has not yet been validated externally or longitudinally. STUDY DESIGN Participants were derived from the GROUP and SCOPE datasets. Participants included 1448 adults with schizophrenia spectrum disorder (SSD), 800 SSD-siblings, 103 adults diagnosed with an autistic spectrum condition (ASC), and 409 typically-developing controls (TC). Analyses from the original validation study were conducted with SSD participants, and extended into ASC, SSD-sibling, and TC participants. Test-retest reliability of the PAUSS at 2-weeks and long-term stability 3 and 6-years was also examined. STUDY RESULTS Results differed in important ways from the original validation. SSD participants reported higher PAUSS scores than other groups, with only a fraction of ASC participants scoring as "PAUSS-Autistic." Cronbach's alpha was acceptable for the SSD cohort only. Two-week stability of the PAUSS was fair to good for all PAUSS scores. Long-term stability was poor for most PAUSS items but fair for total PAUSS score. CONCLUSIONS Results suggest that the PAUSS does not appear appropriate for assessing autism, with the low rate of PAUSS-Autistic in the ASC population suggesting the PAUSS may not accurately reflect characteristics of autism. The relative lack of long-term stability is cause for concern and suggestive that the PAUSS is capturing features of psychosis rather than autism traits.
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Affiliation(s)
- Katharine Chisholm
- School of Psychology, Institute of Health and Neurodevelopment, Aston University, Aston St, Birmingham, B4 7ET, UK
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Amy E Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Noah J Sasson
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Research Service, Miami VA Healthcare System, Miami, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Tim Ziermans
- Department of Psychology, Dutch Autism & ADHD Research Center, University of Amsterdam, Amsterdam, The Netherlands
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13
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Carpita B, Cremone IM, Nardi B, Amatori G, Bonelli C, Massimetti E, Casagrande D, Pini S, Dell’Osso L. Implications of Social Anxiety Symptoms in Adults with Autism Spectrum Disorder: Is There a Predictive Role of Interpersonal Sensitivity and Substance Abuse? Brain Sci 2023; 13:1559. [PMID: 38002519 PMCID: PMC10669824 DOI: 10.3390/brainsci13111559] [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: 10/19/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Social anxiety disorder (SAD) has been frequently reported by subjects with Autism Spectrum Disorder (ASD). However, interestingly, the overlap between social anxiety and autistic traits may sometimes impede ASD diagnosis in subjects without intellectual or language impairment. The aim of the present work was to evaluate the presence and correlates of social phobic features among subjects with ASD, with a specific focus on evaluating which social anxiety symptoms may be statistically predictive of an ASD diagnosis. With this purpose, 48 subjects with ASD and 48 gender- and age- matched healthy controls (HCs) were recruited and assessed with the SHY-SV and the AdAS Spectrum questionnaires. Results highlighted higher scores in all SHY-SV Spectrum domains and total scores for the ASD group. Moreover, AdAS Spectrum scores were significantly correlated with all SHY-SV domain and total scores. A logistic regression analysis highlighted the SHY-SV Interpersonal sensitivity and Substance Abuse domains scores as significant positive predictors of an ASD diagnosis. These results confirm the link between ASD and SAD. Because of this association, particular attention should be paid to subjects with high interpersonal sensitivity traits and substance abuse problems.
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Affiliation(s)
- Barbara Carpita
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Enrico Massimetti
- North-Western Tuscany Region NHS Local Health Unit, Department of Psychiatry, Head Office, Via Cocchi 7/9, 56121 Pisa, Italy
| | - Danila Casagrande
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy (B.N.); (G.A.); (S.P.); (L.D.)
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14
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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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15
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Huyst V, Dewinter J, Noens I, Platteau T, Tsoumanis A. Measuring the prevalence of autistic traits in a cohort of adults living with HIV or taking HIV pre-exposure prophylaxis and mapping safer-sex barriers and facilitators: a study protocol. BMJ Open 2023; 13:e075667. [PMID: 37775292 PMCID: PMC10546106 DOI: 10.1136/bmjopen-2023-075667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Autistic individuals identify with a wider range of sexual orientations than non-autistic individuals, including higher rates of bisexual orientation in autistic men. Gay, bisexual and other men who have sex with men are at greater risk for HIV. Prevalence data of autistic traits in people living with HIV or using Pre-Exposure Prophylaxis (PrEP) for HIV are lacking so far. Such data, combined with insights in barriers and facilitators for safer sex in autistic people living with HIV or using PrEP, are a first step to improve health support for autistic people in HIV clinics. This support is crucial since autistic individuals have worse physical and mental health outcomes. The objective of this research is to determine the prevalence of autistic traits within the group of people living with HIV or using PrEP in Belgium and to describe specific facilitators and barriers for sexual safer behaviour in people living with HIV and PrEP users with autistic traits. METHODS AND ANALYSIS The research is a cross-sectional, observational and multicentre study with recruitment of individual participants. The research consists of two phases. In phase 1, adults coming for HIV/AIDS care or HIV PrEP in participating Belgian HIV Reference Centres will be invited to fill in the validated Autism Spectrum Quotient questionnaire. In phase 2, participants with a score above the predefined cut-off for autistic traits (>26), who agreed to be informed about this score, will be invited to complete an additional survey, inquiring facilitators and barriers for sexual safer behaviour. ETHICS AND DISSEMINATION OF RESULTS Institutional Review Board Institute of Tropical Medicine Antwerp, 25 July 2022, REF 1601/22 and University Hospital of Antwerp, 12 September 2022, Project ID 3679: BUN B3002022000111. Study results will be published in peer-reviewed journals and presented to Belgian HIV Reference Centres and at conferences.
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Affiliation(s)
- Veerle Huyst
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jeroen Dewinter
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ilse Noens
- Parenting and Special Education Research Unit, University of Leuven, Leuven, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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16
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Nyrenius J, Waern M, Eberhard J, Ghaziuddin M, Gillberg C, Billstedt E. Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury. BJPsych Open 2023; 9:e167. [PMID: 37674410 PMCID: PMC10594204 DOI: 10.1192/bjo.2023.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. AIMS We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. METHOD Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. RESULTS In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. CONCLUSIONS Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.
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Affiliation(s)
- Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | - Margda Waern
- Sahlgrenska Suicide Studies, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jonas Eberhard
- Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | | | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
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17
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Underwood JFG, DelPozo-Banos M, Frizzati A, Rai D, John A, Hall J. Neurological and psychiatric disorders among autistic adults: a population healthcare record study. Psychol Med 2023; 53:5663-5673. [PMID: 36189783 PMCID: PMC10482712 DOI: 10.1017/s0033291722002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54-94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. METHODS This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation. RESULTS All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24-10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. CONCLUSIONS We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population.
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Affiliation(s)
- Jack F. G. Underwood
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | | | - Aura Frizzati
- Cedar Healthcare Technology Research Centre, Cardiff & Vale University Health Board, Cardiff, UK
| | - Dheeraj Rai
- Bristol Medical School, Bristol Population Health Science Institute, Bristol, UK
| | - Ann John
- Population Data Science, Medical School, Swansea University, Swansea, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
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18
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So R, Sato Y, Hashimoto N, Furukawa TA. Prevalence of suspected autism spectrum disorder and attention-deficit hyperactivity disorder in a Japanese clinical sample with gambling disorder: A cross-sectional study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e131. [PMID: 38867830 PMCID: PMC11114339 DOI: 10.1002/pcn5.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 06/14/2024]
Abstract
Aim Studies show gambling disorders are associated with attention-deficit hyperactivity disorder (ADHD). The association between gambling disorders and autism spectrum disorder (ASD) has not been well studied, although ASD is often comorbid with ADHD and is associated with gaming disorder. The aim of this study was to estimate the prevalence of ASD and ADHD traits comorbid with gambling disorders and to examine the relationships between these traits and gambling problems in a clinical population. Methods This single-site cross-sectional study was conducted at a Japanese addiction outpatient clinic treating gambling disorders. The Autism-Spectrum Quotient (AQ) test and the Adult ADHD Self-Report Scale (ASRS) were used to screen ASD and ADHD. The Problem Gambling Severity Index (PGSI) was used to assess the severity of the gambling problems. We calculated the prevalence of suspected ASD and ADHD with 95% confidence intervals (CI) based on a binomial distribution and performed univariate analyses to examine the relationships between the AQ and ASRS scores and the total PGSI score. Results We included 97 of 197 potential participants. After screening the participants using the AQ and ASRS, we found that the prevalence of ASD traits was 29.8% (95% CI: 21.0%-40.2%), while the prevalence of ADHD traits was 26.0% (95% CI: 17.9%-36.2%). Univariate regression analyses revealed that the total AQ score was inversely associated with the total PGSI score. However, the total ASRS score and some ASRS subscores were positively associated with the total PGSI score. Conclusion ASD and ADHD may be prevalent among patients with gambling disorders in clinical settings.
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Affiliation(s)
- Ryuhei So
- Department of Health Promotion of Human BehaviorKyoto University Graduate School of Medicine/School of Public HealthKyotoJapan
- Okayama Psychiatric Medical CenterOkayamaJapan
| | | | | | - Toshi A. Furukawa
- Department of Health Promotion of Human BehaviorKyoto University Graduate School of Medicine/School of Public HealthKyotoJapan
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19
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Hofvander B, Nilsson T, Ståhlberg O, Claesdotter E, Moberg P, Ahlbäck K, Hildebrand Karlén M. Autism Spectrum Disorders in forensic psychiatric investigations-patterns of comorbidity and criminality. Front Psychiatry 2023; 14:1168572. [PMID: 37621970 PMCID: PMC10444990 DOI: 10.3389/fpsyt.2023.1168572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Background There are contradictory research findings regarding whether individuals with Autism Spectrum Disorders (ASDs) are more or less likely to commit crimes. The aims of the current study were to: (1) Describe psychiatric and crime-related characteristics of a large group of offenders with ASD who had undergone a Forensic Psychiatric Investigation (FPI). (2) Identify clinical subgroups among this group of offenders. (3) Investigate associations between the identified clinical subgroups and (a) psychiatric comorbidity (b) types of crimes and (c) criminal responsibility. Methods The study cohort consists of all subjects (n = 831) who received an ASD-diagnosis at an FPI between 2002 and 2018 in Sweden. Descriptive and clinical, as well as crime related variables were obtained from the FPIs. Non-parametric (Pearson χ2, Fisher's exact and Mann-Whitney U-test) inferential statistics were used for analyses of between-group differences and effect sizes were reported. A Latent Class Analysis was used to identify homogeneous subgroups (or classes) from categorical characteristics. Results The cohort consisted of 708 men and 123 women, aged 18 to 74 yrs. Two-thirds (66.7%) of the cohort had at least one other psychiatric diagnosis, the most prevalent was substance use disorder (SUD). A severe mental disorder, equivalent to lack of criminal responsibility, was most often reported among offenders with a comorbid diagnosis of schizophrenia spectrum disorder. The most common type of crime was violent crime. Three person-oriented clinical subgroups were identified; (1) ASD with few other diagnoses; (2) ASD and very high levels of SUDs, plus moderate levels of other externalizing disorders and psychotic psychopathology and (3) ASD and moderate to high levels of personality disorders (other than ASPD) and SUDs. Conclusion Our results highlight the importance of all parts of the CJS to be prepared to handle offenders with ASD, often with high levels of additional psychiatric problems. Traditional approaches in treatment or other psychosocial interventions for ASD may need to be adapted to at least three general clinical profiles- one with mainly neurodevelopmental problems, one with a spectrum of externalizing problems and one with complex personality related difficulties.
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Affiliation(s)
- Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Trelleborg, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Nilsson
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Ola Ståhlberg
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Emma Claesdotter
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Patricia Moberg
- Department of Forensic Psychiatry, Region Skåne, Trelleborg, Sweden
| | - Klara Ahlbäck
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Malin Hildebrand Karlén
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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20
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Belcher HL, Morein-Zamir S, Stagg SD, Ford RM. Shining a Light on a Hidden Population: Social Functioning and Mental Health in Women Reporting Autistic Traits But Lacking Diagnosis. J Autism Dev Disord 2023; 53:3118-3132. [PMID: 35593995 PMCID: PMC10313531 DOI: 10.1007/s10803-022-05583-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/28/2022]
Abstract
Female Phenotype Theory (FPT) suggests that autistic women often present with less obvious social impairments than autistic men. We examined the possibility of an exaggerated female phenotype among undiagnosed but probably autistic women. In two nationwide online surveys, we compared self-reported social functioning and mental health between diagnosed autistic women and women without diagnosis who scored ≥ 32 on the Autism Quotient. Compared to diagnosed autistic women, probably autistic women had higher empathy and general social functioning, and were more likely to have received a diagnosis of Borderline Personality Disorder. Autistic women had typically received more mental health diagnoses prior to their ASC diagnosis than autistic men. These findings shed light on the history of misdiagnosis experienced by many autistic women.
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Affiliation(s)
- Hannah L Belcher
- IOPPN, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
| | - Sharon Morein-Zamir
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
| | - Steven D Stagg
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
| | - Ruth M Ford
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
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21
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White SW, Siegle GJ, Kana R, Rothman EF. Pathways to Psychopathology Among Autistic Adults. Curr Psychiatry Rep 2023; 25:315-325. [PMID: 37378790 PMCID: PMC11078254 DOI: 10.1007/s11920-023-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels. RECENT FINDINGS We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems. Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.
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Affiliation(s)
- Susan W White
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Greg J Siegle
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rajesh Kana
- Center for Innovative Research in Autism, Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Emily F Rothman
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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22
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Faerman A, Sakallah A, Skiba S, Kansara S, Kopald BE, Lewine JD, Demopoulos C. Language Abilities are Associated with Both Verbal and Nonverbal Intelligence in Children on the Autism Spectrum. Dev Neuropsychol 2023; 48:248-257. [PMID: 37326312 PMCID: PMC10527100 DOI: 10.1080/87565641.2023.2225663] [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: 02/20/2023] [Revised: 04/28/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
Intellectual abilities factor into levels of functioning used to characterize autism. Language difficulties are highly prevalent in autism and may impact performance on measures of intellectual abilities. As such, nonverbal tests are often prioritized in classifying intelligence in those with language difficulties and autism. However, the relationship between language abilities and intellectual performance is not well characterized, and the superiority of tests with nonverbal instructions is not well established. The current study evaluates verbal and nonverbal intellectual abilities in the context of language abilities in autism and the potential benefit of tests with nonverbal instructions. Participants were 55 children and adolescents on the autism spectrum who underwent a neuropsychological evaluation as part of a study examining language functioning in autism. Correlation analyses were performed to examine relations between expressive and receptive language abilities. Language abilities (CELF-4) were significantly correlated with all measures of both verbal (WISC-IV VCI) and nonverbal intelligence scores (WISC-IV PRI and Leiter-R). There were no significant differences between nonverbal intelligence measures with verbal or nonverbal instructions. We further discuss the role of assessment of language abilities in interpreting results of intelligence testing in populations with higher prevalence of language difficulties.
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Affiliation(s)
- Afik Faerman
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Alaa Sakallah
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Division of Clinical Behavioral Neuroscience, University of Minnesota, USA
| | - Sara Skiba
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Seemran Kansara
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Brandon E Kopald
- Department of Neurology, University of California, San Francisco, USA
| | - Jeffrey David Lewine
- Departments of Neurology and Psychology, University of New Mexico, USA
- Mind Research Network, Albuquerque, New Mexico, USA
| | - Carly Demopoulos
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Departments of Radiology & Biomedical Imaging, University of California, San Francisco, California
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23
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Cano-Villagrasa A, Moya-Faz FJ, Cortés-Ramos A, López-Zamora M. Emotional and behavioral alterations and their relationship with executive functioning in the pediatric population with autism spectrum disorder and epilepsy: a comparative study. Front Psychol 2023; 14:1219177. [PMID: 37457105 PMCID: PMC10348750 DOI: 10.3389/fpsyg.2023.1219177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction The pediatric population with Autism Spectrum Disorder (ASD) and epilepsy presents behavioral and emotional alterations that hinder their correct developmental maturation as well as their integration in different contexts such as school, family or social. This population shows atypical behavioral and emotional patterns, with difficulties in emotional regulation, understanding of emotions, aggressiveness, or low frustration tolerance. They also present alterations in executive functions, which significantly influence the emotional and behavioral characteristics of this population. Research suggests that epilepsy worsens the emotional, behavioral, and executive functioning status. Objective To explore differences in behavioral, emotional, and executive functioning profile in individuals with a diagnosis of ASD, epilepsy, and ASD with epilepsy. Method In this quasi-experimental and cross-sectional study, a total of 170 participants were selected and distributed into three groups: a group of participants with ASD, a group with epilepsy, and a group of participants with ASD and epilepsy. The SENA, BASC-3, and ENFEN tests were administered to verify the behavioral, emotional, and executive functioning profile in the three groups. Results The results indicate that individuals diagnosed with ASD and epilepsy present greater emotional, behavioral, and executive functioning alterations compared to those who only present ASD or epilepsy. Conclusion Individuals with ASD and epilepsy present significant alterations in emotional, behavioral, and executive functioning processes, which hinder their adaptation to different contexts, as well as decreasing their quality of life and that of their family.
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Affiliation(s)
- Alejandro Cano-Villagrasa
- Health Sciences PhD Program, Departamento de Psicología Básica, Facultad de Ciencias de la Salud, Universidad Católica de Murcia UCAM, Murcia, Spain
- Universidad Internacional de Valencia, Valencia, Spain
| | - Francisco J. Moya-Faz
- Cátedra Psicogeriatría, Facultad de Medicina, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Antonio Cortés-Ramos
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
| | - Miguel López-Zamora
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
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Dell'Osso L, Carpita B, Nardi B, Benedetti F, Dell'Oste V, Massimetti G, Cremone IM, Barlati S, Castellini G, Luciano M, Bossini L, Rocchetti M, Signorelli MS, Ricca V, Aguglia E, Fagiolini A, Vita A, Politi P, Maj M. Autistic traits distribution in different psychiatric conditions: A cluster analysis on the basis of the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire. Psychiatry Res 2023; 326:115270. [PMID: 37320989 DOI: 10.1016/j.psychres.2023.115270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
Increasing interest is being paid on full-threshold and sub-threshold autism spectrum conditions among adults. Sub-threshold autistic traits (AT) seem to be distributed in a continuum from the clinical to the general population, being particularly higher among subjects with other psychiatric disorders. The aim of the present study was to evaluate the distribution of AT in a sample of subjects with different psychiatric conditions by means of a cluster analysis on the basis of the score reported to the AdAS Spectrum instrument. A total of 738 subjects recruited by seven Italian Universities were divided in 5 groups depending on the clinical diagnosis: Autism spectrum disorder (ASD), subthreshold ASD symptoms (partial ASD), Bipolar disorder (BD), Feeding and eating disorders (FED), and controls (CTLs). All subjects were assessed with the AdAS Spectrum. The cluster analysis identified 3 clusters: the high, medium and low autism clusters. The Restricted interests and rumination domain reported the highest influence in forming the clusters. The high, medium and low autism clusters were respectively more represented in the ASD, partial ASD and CTL groups. The clusters were represented intermediately in the FED and BD groups, confirming the presence of intermediate levels of AT in these clinical populations.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy.
| | - Bendetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giovanni Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Letizia Bossini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Fagiolini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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25
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Dell'Osso L, Cremone IM, Nardi B, Tognini V, Castellani L, Perrone P, Amatori G, Carpita B. Comorbidity and Overlaps between Autism Spectrum and Borderline Personality Disorder: State of the Art. Brain Sci 2023; 13:862. [PMID: 37371342 DOI: 10.3390/brainsci13060862] [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] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the relationship between Autism spectrum disorder (ASD) and personality disorders (PD) still being scarcely understood, recent investigations increased awareness about significant overlaps between some PD and autism spectrum conditions. In this framework, several studies suggested the presence of similarities between BPD and ASD symptoms and traits, based on the recent literature that increasingly reported increased comorbidity rates and significant symptomatologic overlaps between the two conditions. The aim of this review is to describe the available studies about the prevalence of the association between different forms of autism spectrum (full-fledged clinical conditions as well as subthreshold autistic traits) and BPD. Despite some controversial results and lack of homogeneity in the methods used for the diagnostic assessment, the reviewed literature highlighted how subjects with BPD reported higher scores on tests evaluating the presence of AT compared to a non-clinical population and hypothesized the presence of unrecognized ASD in some BPD patients or vice versa, while also describing a shared vulnerability towards traumatic events, and a greater risk of suicidality in BPD subjects with high autistic traits. However, the specific measure and nature of this association remain to be explored in more depth.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Valeria Tognini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Lucrezia Castellani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Paola Perrone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy
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26
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Criss SD, Kakulamarri S, Xu RF, Fajardo M, Keeney T, Tolchin DW, May CJ. The Healthcare Experience of Autistic Patients in Orthopaedic Surgery and Closely Related Fields: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050906. [PMID: 37238454 DOI: 10.3390/children10050906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Orthopaedic and related care has the potential to present unique obstacles for patients with a range of autism manifestations. In this review, we aim to describe and analyze the literature on autistic patients' experience within orthopaedics and closely related fields. This literature search utilized the PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases. Three major concepts were built into the search terms: (1) patients on the autism spectrum; (2) patient experience; and (3) movement sciences, including orthopaedics, physical medicine and rehabilitation (PM&R), occupational therapy (OT), and physical therapy (PT). Our search yielded 35 topical publications, with the major topic areas addressed as follows: (1) clinical and perioperative management, (2) therapy interventions, (3) participation in exercise and social play, (4) sensory management and accommodations, (5) caregiver/parent training and involvement in care, (6) healthcare needs and barriers to care, and (7) utilization of technology. In the current literature, there are no studies that attempt to directly assess autistic patient experience with care practices and clinical environments in orthopaedics. Rigorous, direct examination of the experience of autistic patients within clinical orthopaedic settings is urgently needed to address this gap.
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Affiliation(s)
| | | | - Raylin F Xu
- Harvard Medical School, Boston, MA 02115, USA
| | - Maya Fajardo
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Tamra Keeney
- Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dorothy W Tolchin
- Department of Physical Medicine and Rehabilitation, Mass General Brigham, Boston, MA 02114, USA
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Collin J May
- Harvard Medical School, Boston, MA 02115, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA
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27
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Khasakhala E, Bota K, Ayaga G, Sichari M, Wesonga B, Kokonya D. Comorbidity of mental health and autism spectrum disorder: perception of practitioners in management of their challenging behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:386-397. [PMID: 37213594 PMCID: PMC10197977 DOI: 10.1080/20473869.2023.2203531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
The relationship between mental health problems, Autism Spectrum Disorder (ASD) and challenging behaviour among children and adolescents is complex and multifaceted. The study investigated practitioners' perception of comorbidity of mental health and ASD in the management of challenging behaviours among children and adolescents in Kenya. Target population was 3490 practitioners. Sample size was 1047, comprising of 38 assessment staff, 27 mental health workers 548 regular teachers, 294 teachers from special schools, and 140 teachers from special units for children with ASD. Stratified and purposive sampling techniques were used. Interviews and structured questionnaires were used. Test-retest yielded a coefficient of 0.78 while Cronbachs' reliability coefficient was 0.830. There was a positive significant correlation between perception of challenging behaviours and mental health problems (r = .415, p = .000). Challenging behaviour perceptions have a negative significant effect on behaviour management strategies, (β = -0.163, p = .000) implying that the choice of management strategies is dependent on the perceptions. Challenging behaviours accounts for 2.7% variance in the choice of the management strategies, R2 = .027, F(1,1045) = 28.471, p = .000.The practitioners' perception of mental health and comorbid ASD, showed that children with ASD, when enduring life stressors, can be at a higher risk of mental health difficulties than their peers There is need for multidisciplinary synergy in developing effective challenging behaviour programmes for children and adolescents with ASD.
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Affiliation(s)
- Edward Khasakhala
- Department of Educational Psychology, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Kennedy Bota
- Department of Educational Psychology, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Godfrey Ayaga
- Department of Educational Psychology, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Manson Sichari
- Department of Educational Psychology, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Benard Wesonga
- Department of Community Health and Behavioural Sciences, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Donald Kokonya
- Department of Psychiatry, Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
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Dell'Osso L, Bonelli C, Nardi B, Amatori G, Cremone IM, Carpita B. Autism Spectrum Disorder in a Patient with Bipolar Disorder and Its Relationship with Catatonia Spectrum: A Case Study. Brain Sci 2023; 13:brainsci13050704. [PMID: 37239176 DOI: 10.3390/brainsci13050704] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
According to several studies, the prevalence of Autism Spectrum Disorder (ASD) ranges from 2.4 to 9.9 percent among adult mental inpatients. However, subjects with forms of ASD that fit in the high functioning spectrum may remain undiagnosed during childhood and adolescence without reaching clinical attention until they develop in adult life other psychiatric disorders, often characterized by treatment resistance and poor outcomes. The aim of this case report was to evaluate the role of an undiagnosed ASD in the mental illness trajectory and discuss the diagnostic and therapeutic implications. We reported a case of a young man with an undiagnosed ASD that came to clinical attention only after the development of a severe manic episode with mixed and psychotic features and with catatonia in adulthood, despite meeting DSM-5-TR (APA, 2022) diagnostic criteria for ASD since early childhood. This case confirms the need of a timely identification of ASD in order to prevent the development of a mental illness trajectory and to improve the prognosis and the outcome. Moreover, on the heuristic level, this case seems to support the presence of a continuum between ASD and catatonia. In this framework, the use of a questionnaire based on a spectrum model, such as the AdAS Spectrum, could be useful in early diagnosis of ASD without intellectual or language impairment as well as in early detection of subthreshold conditions (broad autism spectrum phenotype or autistic traits), which represents a vulnerability factor for the development of various mental disorders.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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29
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Antolini G, Colizzi M. Where Do Neurodevelopmental Disorders Go? Casting the Eye Away from Childhood towards Adulthood. Healthcare (Basel) 2023; 11:healthcare11071015. [PMID: 37046942 PMCID: PMC10094062 DOI: 10.3390/healthcare11071015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Neurodevelopmental disorders (NDDs) encompass a group of complex conditions with onset during the early developmental period. Such disorders are frequently associated with a number of neuropsychiatric features, the most prevalent ones being autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability, communication and specific learning disorders, and motor disorders. These conditions are characterized by wide genetic and clinical variability, and although they were previously conceptualized as childhood-limited disorders, NDDs are progressively being recognized as persistent conditions with a potentially relevant impact on the quality of life and overall functioning during adult life. In addition, emerging evidence seems to point towards the hypothesis of a neurodevelopmental continuum, according to which NNDs could portray different time-dependent outcomes, depending on the severity of the altered brain development. Despite representing lifelong phenotypes, they are often not promptly identified and/or managed in adulthood. In this regard, specific guidelines on clinical and therapeutic approaches for these conditions have not yet been delineated. In this view, future research investigations should be encouraged to broaden available knowledge, characterize the clinical course of NDDs across an individual’s lifespan, and better understand the patterns of aging-related concerns in adults with an NDD diagnosis. Additionally, considering the difficulties many young adults encounter while transitioning from childhood to adult mental health services, new, specific programs should be developed and existing programs should be implemented to improve the transition process and for the management of NDDs in adulthood.
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Affiliation(s)
- Giulia Antolini
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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Kopp S, Asztély KS, Landberg S, Waern M, Bergman S, Gillberg C. Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation. J Atten Disord 2023; 27:830-846. [PMID: 36915033 DOI: 10.1177/10870547231158751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood. METHODS Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed. RESULTS At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women. CONCLUSION Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.
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Affiliation(s)
- Svenny Kopp
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | | | - Sara Landberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Margda Waern
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Stefan Bergman
- University of Gothenburg Institute of Medicine, Göteborg, VG Region, Sweden
| | - Christopher Gillberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
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“I Always Knew I Was Different”: Experiences of Receiving a Diagnosis of Autistic Spectrum Disorder in Adulthood—a Meta-Ethnographic Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AbstractA broadening of diagnostic criteria and increased awareness of autism has led to a large number of individuals whose difficulties remained undetected until adulthood. This systematic review aimed to synthesise empirical evidence of the experience of individuals who received their diagnosis of autism in adulthood. Eight studies met the inclusion criteria. A meta-ethnographic approach was used to synthesise the findings. Analysis revealed two meta-themes: feeling “like an alien” and the “not guilty” verdict, each with three associated subthemes. The findings indicate the need for timely diagnosis and provision of post-diagnostic support to alleviate the mental health implications of not having a framework to understand one’s experiences and to support the process of adjustment to the diagnosis.
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Association between autistic traits and binge drinking: Findings from Japan. Soc Psychiatry Psychiatr Epidemiol 2023; 58:217-226. [PMID: 35610390 DOI: 10.1007/s00127-022-02299-7] [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: 08/18/2021] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Substance misuse may be elevated in some individuals with autism spectrum disorder (ASD). As yet, however, little is known about the association between autistic traits (AT) and substance use/misuse in adults. This study examined the association between AT and binge drinking (BD) among individuals in Japan. METHODS Data were analyzed from 1452 individuals aged 18 and above collected during an online survey in February 2021. Self-reported information was obtained on BD assessed as consuming 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol within a 2-h period. AT were assessed with the Japanese version of the Autism Spectrum Quotient - the AQ-J-10. Logistic regression analysis was used to examine associations. RESULTS The prevalence of past-month BD was significantly higher in individuals with AT compared to those without AT (42.7% > 27.6%). In a fully adjusted analysis that controlled for mental health (anxiety, depression) and attention-deficit/hyperactivity disorder symptoms, individuals with AT had significantly higher odds for BD once a week or more often (OR: 1.54, 95%CI: 1.04-2.29). AT were also associated with significantly higher odds for BD among women (OR: 2.27, 95%CI: 1.08-4.76), and those aged 18-34 (OR: 2.37, 95%CI: 1.09-5.18) and aged 60 and above (OR: 2.15, 95%CI: 1.02-4.53). CONCLUSION Individuals with AT have higher odds for BD. Increased efforts to detect alcohol use/misuse in adults with AT and AT in adults misusing alcohol may be efficacious in efforts to manage symptoms and eliminate harmful alcohol misuse.
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Lewis LF. Autism as a difference or a disorder? Exploring the views of individuals who use peer-led online support groups for autistic partners. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:321-330. [PMID: 35652377 DOI: 10.1177/13623613221097850] [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: 02/02/2023]
Abstract
LAY ABSTRACT Individuals who use peer-led online support groups for partners of autistics describe diverse views of autism, with some describing autism as a difference and others describing it as a disorder. I conducted online interviews with 162 non-autistics who believed they were in relationships with autistics and who participated in online support groups on social media. I analyzed their responses by constantly comparing each interview to previous interviews to develop a theory about their social experiences. As many as one-third of autistics participate in romantic relationships, and many of their partners seek support through groups on social media. Few studies explore what it is like to be a non-autistic person who is in a relationship with an autistic person. The way that participants viewed autism influenced the way that they viewed themselves, their partners, and their relationships. Many participants who were dissatisfied in their relationships shared that they believed their partners were autistic, but their partners had never been formally evaluated and did not self-identify as autistic. Future research should explore ways that autism labels are (mis)applied by the general public based on negative stereotypes about autism.
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Finding the Proportion of Females with Autistic Spectrum Disorder Who Develop Anorexia Nervosa, the True Prevalence of Female ASD and Its Clinical Significance. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020272. [PMID: 36832401 PMCID: PMC9955974 DOI: 10.3390/children10020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by the age of 18. This translates to a prevalence of about 5-6%, and if true, has serious implications for female mental health. One way of finding the true value is to use Bayes' Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and, with four other methods, a median prevalence of 6% for female ASD. The clinical implications of the diagnosis and management of ASD and its comorbidities are discussed and, as an example, a solution is provided for the rate of ASD in symptomatic generalized joint hypermobility. It is probable that one in six women with a mental health condition is autistic.
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35
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Sturrock A, Freed J. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure. Front Psychol 2023; 13:982676. [PMID: 36798644 PMCID: PMC9928212 DOI: 10.3389/fpsyg.2022.982676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Many language disordered groups experience emotional difficulties; Developmental Language Disorders, Attention Deficit Hyperactivity Disorder and autism. However, (as in the case of autism) research tends to focus on assessing recognition of emotional states, rather than exploring labeling skills. Where labeling is assessed, measures have focused on early-acquired vocabulary (happy, sad, angry) or self/parent reporting. To date, no objective assessment has been made of vocabulary of emotion across childhood. Methods This study uses an experimental psycholinguistic measure, The Emotion Vocabulary: Expressive and Receptive ability measure (EVER) which includes two tasks (receptive vocabulary and word generation/expressive vocabulary). This measure has capacity to demonstrate vocabulary growth across age groups. 171 participants (5.0-13.11 years) completed The EVER Measure, alongside two closely matched standardized measures of basic language: BPVS (receptive vocabulary task) and CELF (word-association task). Assessments were completed online and en vivo (COVID testing restrictions dependent). Results As predicted, children's accuracy increased on both receptive and expressive emotion vocabulary tasks, in line with age at time of testing. EVER scores were significantly predicted by age and correlated with matched basic language scores. Secondary analysis provided preliminary findings on age of acquisition for specific emotion vocabulary items. Discussion The findings consequently demonstrate proof of concept for the use of The EVER Measure in assessing emotional vocabulary across childhood. This study provides important preliminary data on generating and recognizing emotion labels across typical child development. Critically, it extends current knowledge on emotion vocabulary acquisition into middle childhood, where linguistic ability is relatively mature. As such, findings have implications for research with potential clinical application in the assessment of older children, with either language or emotional differences or both. Findings demonstrate the need for a standardized tool, and its potential application in research and clinical practice is explored. A large-scale study offering proof of concept and reliability of The EVER Measure is indicated.
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Allely CS, Woodhouse E, Mukherjee RA. Autism spectrum disorder and personality disorders: How do clinicians carry out a differential diagnosis? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613231151356. [PMID: 36708368 PMCID: PMC10374990 DOI: 10.1177/13623613231151356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
LAY ABSTRACT It is now recognised that autism spectrum disorder (ASD) and personality disorders (PDs) have a variety of factors in common. However, the exact nature of the relationship between ASD and the PDs remains unclear. The overlapping symptom profiles of ASD and PDs can lead to diagnostic uncertainty - features of ASD and PD can be misattributed and easily lead to misdiagnosis of ASD patients. Since differentiating between ASD and PD is such a complex task, it has been argued that there is a need for additional understanding and markers for facilitating diagnostic procedures. There is an urgent need to explore, first, how clinicians make diagnostic decisions and, second, how to effectively deal with the challenges and difficulties they face when making decisions. Also, where there are clear overlaps, how do clinicians choose how to attribute labels in order to understand the person.
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Affiliation(s)
| | - Emma Woodhouse
- King's College London, UK.,Compass Psychology Services, UK
| | - Raja As Mukherjee
- University of Salford, UK.,Surrey and Borders Partnership NHS Foundation Trust, UK
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Feller C, Ilen L, Eliez S, Schneider M. Characterizing Daily-Life Social Interactions in Adolescents and Young Adults with Neurodevelopmental Disorders: A Comparison Between Individuals with Autism Spectrum Disorders and 22q11.2 Deletion Syndrome. J Autism Dev Disord 2023; 53:245-262. [PMID: 35018586 PMCID: PMC9889413 DOI: 10.1007/s10803-021-05423-9] [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: 12/21/2021] [Indexed: 02/04/2023]
Abstract
Social impairments are common features of 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). The Ecological Momentary Assessment (EMA) allowed access to daily-life information in order to explore the phenomenology of social interactions. 32 individuals with 22q11DS, 26 individuals with ASD and 44 typically developing peers (TD) aged 12-30 were assessed during 6 days 8 times a day using a mobile app. Participants with 22q11DS and ASD did not spend more time alone but showed distinct implication in the social sphere than TD. Distinct profiles emerged between the two conditions regarding the subjective experience of aloneness and the subjective experience of social interactions. This study highlights distinct social functioning profiles in daily-life in 22q11DS and ASD that points towards different therapeutic targets.
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Affiliation(s)
- Clémence Feller
- grid.8591.50000 0001 2322 4988Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d’Arve, 1205 Geneva, Switzerland
| | - Laura Ilen
- grid.8591.50000 0001 2322 4988Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d’Arve, 1205 Geneva, Switzerland
| | - Stephan Eliez
- grid.8591.50000 0001 2322 4988Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- grid.8591.50000 0001 2322 4988Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d’Arve, 1205 Geneva, Switzerland ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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Ben Hassen N, Molins F, Garrote-Petisco D, Serrano MÁ. Emotional regulation deficits in autism spectrum disorder: The role of alexithymia and interoception. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 132:104378. [PMID: 36410287 DOI: 10.1016/j.ridd.2022.104378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/28/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to analyze emotional regulation, alexithymia and interoception in a group of people diagnosed with ASD (n = 27), a normative population with a technical academic training (n = 30), and another group with a humanities/health training (n = 20). Results showed significantly higher scores in alexithymia and emotional regulation problems, and lower scores in interoception in the ASD group. Also, alexithymia was found to correlate with emotional regulation, which was found to be significant in all three groups. In addition, interoception correlated negatively with alexithymia in the ASD group. Finally, the scores of the group with the technical training were closer to those of the ASD group compared to the humanities/health group.
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Affiliation(s)
- Nour Ben Hassen
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010 Valencia, Spain
| | - Francisco Molins
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010 Valencia, Spain
| | | | - Miguel Ángel Serrano
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010 Valencia, Spain.
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Hancock A, Northcott S, Hobson H, Clarke M. Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:52-66. [PMID: 36117337 PMCID: PMC10087343 DOI: 10.1111/1460-6984.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/23/2022] [Indexed: 06/13/2023]
Abstract
BACKGROUND While the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co-occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas. AIMS To explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co-occurring SLCN and mental health difficulties. METHODS & PROCEDURES Semi-structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data. OUTCOMES & RESULTS Participants felt that SLCN and mental health difficulties frequently co-occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well-being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial. CONCLUSIONS & IMPLICATIONS Future research should explore and evaluate current services and service set-up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population. WHAT THIS PAPER ADDS What is already known on the subject Research suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well-being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under-researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties. What this paper adds to existing knowledge SLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co-occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined. What are the potential or actual clinical implications of this work? This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention-based studies.
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Affiliation(s)
- Annabel Hancock
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Sarah Northcott
- Division of Language and Communication ScienceCity University of LondonLondonUK
| | | | - Michael Clarke
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
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Yoshimura A, Matsushita S, Kimura M, Yoneda JI, Maesato H, Yokoyama A, Higuchi S. Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals. BMC Psychiatry 2022; 22:803. [PMID: 36536366 PMCID: PMC9762023 DOI: 10.1186/s12888-022-04455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While several studies have revealed that neurodevelopmental disorders have a high probability of overlapping with substance use disorders, the effects of neurodevelopmental disorders on the courses of substance use disorders have hardly been examined. METHODS This study targeted 637 alcohol-dependent individuals who received inpatient treatment and whose drinking situations were followed for 12 months after hospital discharge using mailed questionnaires. The comorbidity of psychiatric disorders and the characteristics associated with the neurodevelopmental disorders were assessed using several measurements at the time of hospital admission. The effects of neurodevelopmental disorders on the drinking courses of the subjects were then estimated. RESULTS The presence of a current depressive episode or any anxiety disorder significantly lowered the abstinence rates during the follow-up period (p = 0.0195 and p = 0.0214, respectively). ADHD traits as assessed using the ADHD Self-report Scale (ASRS) predicted a significantly poorer abstinence rate (p = 0.0296). Similarly, attention-deficit characteristics assessed objectively through interviews predicted a significantly lower abstinence rate (p = 0.0346), and a sensitivity analysis enhanced these results (p = 0.0019). When the drinking patterns were classified into three groups, the subjects with attention-deficit characteristics had a significantly higher rate of "Recurrence" and lower rates of "Abstinence" and "Controlled drinking" (p = 0.013). In a multivariate proportional hazards analysis, the ASRS score was significantly correlated with the re-drinking risk (p = 0.003). CONCLUSION ADHD traits had significant effects on not only abstinence rates, but also on drinking pattern. The presence of ADHD traits, especially attention-deficit characteristics, influenced the drinking courses of alcohol-dependent individuals after hospital treatment.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan. .,Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Sachio Matsushita
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Mitsuru Kimura
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Jun-ichi Yoneda
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Hitoshi Maesato
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Akira Yokoyama
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
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Vuijk R, Deen M, Geurts HM, Arntz A. Schema therapy for personality disorders in autistic adults: Results of a multiple case series study. Clin Psychol Psychother 2022; 30:458-472. [PMID: 36522138 DOI: 10.1002/cpp.2817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied and is still in its infancy. We investigated the effectiveness of schema therapy (ST) for autistic adults with PD. METHOD A multiple case series design with 12 adults (aged 19-62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques) and follow-up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment and monthly during follow-up. Schema modes, general mental health symptoms, social responsiveness, PD traits and common Axis-I mental disorders were assessed. RESULTS Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD traits, general mental health symptoms and social responsiveness. Results remained stable during follow-up. CONCLUSION The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits and general mental health symptoms and in increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals.
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Institute of Psychology, Methodology and Statistics Unit, Leiden University, Leiden, The Netherlands
| | - Hilde M Geurts
- University of Amsterdam, Amsterdam, The Netherlands.,Leo Kanner Huis (Youz; Parnassia Psychiatric Institute), Amsterdam, The Netherlands
| | - Arnoud Arntz
- University of Amsterdam, Amsterdam, The Netherlands
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Abd Elgawad A, Elbatrawy A, Shorub E, Ramadan M, Elkhatib H. Autistic traits and obsessive-compulsive personality traits in OCD patients. MIDDLE EAST CURRENT PSYCHIATRY 2022. [PMCID: PMC9188838 DOI: 10.1186/s43045-022-00213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Studies have reported a high prevalence of autism spectrum disorder in young people with obsessive-compulsive disorder with a negative effect on psychosocial functioning. However, the extent to which autism spectrum disorder and obsessive-compulsive personality disorder traits overlap and by inference, the extent to which these separately classified Diagnostic and Statistical Manual of Mental Disorders disorders five (obsessive-compulsive personality disorder, personality disorder, autism spectrum disorder, neurodevelopmental disorder) may share a nosological relationship has not so far been systematically investigated in clinical samples. This study is done to detect the frequency of obsessive-compulsive personality traits and autistic traits in a sample of patients with obsessive-compulsive disorder. Results Results revealed that younger patients had significantly more severe and extreme obsessive-compulsive disorder scores. Moreover, Structured Clinical Interview for DSM-IV (SCID-II) and Autism Spectrum Quotient analysis revealed that younger patients had a significantly higher prevalence of personality traits and autistic traits respectively. Statistical significance as many patients with severe and extreme Yale-Brown Obsessive-Compulsive Scale showed criteria of obsessive-compulsive personality disorder. No association of statistical significance was found between obsessive-compulsive disorder severity and autistic trait presence. On the contrary, statistical significance was found between autistic traits and obsessive-compulsive personality disorder. Conclusions There is the presence of comorbidity of obsessive-compulsive personality traits and autism spectrum traits in obsessive-compulsive disorder patients. Obsessive-compulsive personality traits prevalence in obsessive-compulsive disorder patients was higher than in autistic traits. Several factors of genetic predisposition, environmental factors like education and marital status, employment, and intrinsic factors as age of patients all exhibited a pivotal role in obsessive-compulsive disorder prevalence and severity.
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Blackmore CE, Woodhouse EL, Gillan N, Wilson E, Ashwood KL, Stoencheva V, Nolan A, McAlonan GM, Robertson DM, Whitwell S, Deeley Q, Craig MC, Zinkstok J, Wichers R, Spain D, Roberts G, Murphy DGM, Murphy CM, Daly E. Adults with autism spectrum disorder and the criminal justice system: An investigation of prevalence of contact with the criminal justice system, risk factors and sex differences in a specialist assessment service. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2098-2107. [PMID: 35261275 PMCID: PMC9596951 DOI: 10.1177/13623613221081343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
LAY ABSTRACT There has been growing interest in offending and contact with the criminal justice system (CJS) by people with autism spectrum disorder (ASD). However, it is not clear whether people with ASD offend more than those without ASD. Studies have started to look at whether there are particular offences people with ASD are more likely to commit and whether there are any factors that can affect whether someone comes into contact with the CJS as a potential suspect. This study looked at the patients who attended an ASD diagnostic service over a 17-year period to see the rate of contact with the CJS of those who were diagnosed with ASD and whether there were any particular factors that might increase the risk of CJS contact. Nearly a quarter of the ASD group had some contact with the CJS as a potential suspect. Factors that seemed to increase whether someone with ASD was more likely to have contact with the CJS were being male, being diagnosed with ADHD, and being diagnosed with psychosis. This study is one of the largest studies to investigate the rate of CJS contact as a potential suspect in a sample of adults with ASD in an attempt to give a clearer picture of what might influence someone with ASD to engage in offending behaviour in order to try to see what mental health services can offer to reduce the likelihood of someone with ASD coming into contact with the CJS, for example, treatment for another condition or support.
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Affiliation(s)
| | - Emma L Woodhouse
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Nicola Gillan
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Ellie Wilson
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Karen L Ashwood
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Grainne M McAlonan
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Quinton Deeley
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Janneke Zinkstok
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
- University Medical Center Utrecht, The Netherlands
| | - Rob Wichers
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Ged Roberts
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Declan GM Murphy
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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Jadav N, Bal VH. Associations between co-occurring conditions and age of autism diagnosis: Implications for mental health training and adult autism research. Autism Res 2022; 15:2112-2125. [PMID: 36054777 PMCID: PMC9637770 DOI: 10.1002/aur.2808] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/16/2022] [Indexed: 01/09/2023]
Abstract
Adult autism studies are increasingly comprised of later-diagnosed adults, yet little is known about how these adults compare to those diagnosed earlier in life. The present study examines medical and psychiatric conditions endorsed by autistic adults and documents differences between those diagnosed with ASD in childhood versus adulthood, as well as across age groups and sex at birth. 4657 legally independent adults (ages 18-85, M = 33.4 years) with professional ASD diagnoses who completed a medical questionnaire were drawn from the Simons Powering Autism Research Knowledge (SPARK) study. Chi square analyses, t-tests, and logistic regressions were used to compare medical and psychiatric conditions between age groups, sex at birth and adults diagnosed in childhood (before age 21) versus adulthood (at or after 21 years). Overall number of conditions endorsed as being diagnosed by a professional was high, with an average of 1.69 (SD = 2.01) medical or developmental and 2.98 (SD = 2.29) psychiatric conditions reported across the sample. Females were more likely to endorse psychiatric conditions (OR = 1.68). Adult-diagnosed adults were more likely to endorse psychiatric conditions (OR = 2.71) and reported more lifetime psychiatric diagnoses (M = 3.15, SD = 2.23) than their childhood-diagnosed counterparts (M = 2.81, SD = 2.33). These findings underscore the need for research to better understand and treat co-occurring psychiatric conditions in autistic adults and report and consider the age of diagnosis in adult autism samples. Moreover, results suggest it is imperative that mental health professionals receive autism training to promote accurate differential diagnosis and equitable access to mental health care for autistic adults with co-occurring psychiatric conditions.
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Affiliation(s)
- Nikita Jadav
- Graduate School of Applied and Professional PsychologyRutgers University – New BrunswickPiscatawayNew JerseyUSA
| | - Vanessa H. Bal
- Graduate School of Applied and Professional PsychologyRutgers University – New BrunswickPiscatawayNew JerseyUSA
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Amadori S, Barbuti M, Perugi G. Pharmacotherapy for bipolar disorder in adults with high-functioning autism. Expert Opin Pharmacother 2022; 23:1753-1760. [PMID: 36263803 DOI: 10.1080/14656566.2022.2138332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The association between high-functioning autism (HFA) and bipolar disorder (BD) in adult subjects has been confirmed by a growing number of studies. However, identifying and treating BD in this population is a clinical challenge and requires careful assessment and adequate knowledge of both disorders. AREAS COVERED This review aims to provide a clinical presentation of mood episodes in HFA individuals, and an update on the pharmacotherapy of BD in these individuals, sharing with the reader expert opinion on the current state of the art and future perspectives. EXPERT OPINION BD has an atypical clinical presentation in HFA subjects with the possibility of diagnostic and therapeutic mistakes. Despite the absence of controlled studies, the available evidence indicates mood stabilizers, especially lithium, as the first treatment option. HFA subjects are particularly vulnerable to pharmacological side effects, such as extrapyramidal and catatonic symptoms with antipsychotics, or activation syndrome with antidepressants. Accordingly, initial titration of these drugs should be slow and their use should be limited in time. Among antipsychotics, dopamine receptor antagonists with combined serotonergic activity are preferable. Further research is needed to improve the diagnostic process and to delineate the effectiveness of different drugs for BD in HFA subjects.
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Affiliation(s)
- Salvatore Amadori
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa (PI), Italy
| | - Margherita Barbuti
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa (PI), Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa (PI), Italy
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Kilanko A, Obi-Azuike C, Adaralegbe N, Eze-Njoku C, Urhi A, Agbor C, Ayisire OE, Eche VC, Soomro F, Kaur G, Babalola F, Oyeleye-Adegbite OC, Aladum B, Popoola HA, Anugwom GO. The Correlation Between Autistic Childhood Disorders and the Development of Anxiety and Depression in Adults: A Systematic Review. Cureus 2022; 14:e30093. [PMID: 36381917 PMCID: PMC9642317 DOI: 10.7759/cureus.30093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
Children with autism spectrum disorder significantly suffer from other mental conditions, including anxiety and depression, compared to the general population. This continues to have a significant effect till adulthood. This study aimed at determining if there is a correlation between autism disorder in childhood and the development of anxiety and depression in adulthood and if behavioral therapy for children with this disorder reduces the likelihood of developing anxiety and depression as an adult. Three major databases were searched: EMBASE, Google Scholar, and PubMed, using specific search terms. Studies were selected according to population, exposure, comparison, condition or outcome(s) of interest, study design, and context. Overall, there are five articles relevant to this systematic review synthesis; all were observational studies. Our study shows psychiatric disorders like anxiety and depression could be related to autism spectrum disorder and early behavioral intervention could be beneficial and reduce the need for anxiety and depression medication.
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Affiliation(s)
| | - Crystal Obi-Azuike
- Psychiatry and Behavioral Sciences, University of Medicine and Health Sciences, New York City, USA
| | - Ngozi Adaralegbe
- Psychiatry and Behavioral Sciences, University of Connecticut, Waterbury, USA
| | - Chioma Eze-Njoku
- Pediatrics, Atrium Health Navicient the Medical Center, Macon, USA
| | | | - Chukwudi Agbor
- Psychiatry, Tees, Esk and Wear Valleys NHS Trust, Scarborough, GBR
| | | | - Victor C Eche
- Psychiatry, University of Port Harcourt, Port Harcourt, NGA
| | - Fareena Soomro
- Psychiatry and Behavioral Sciences, Isra University, Sindh, PAK
| | - Garima Kaur
- Psychiatry, All Indian Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Funmilola Babalola
- Epidemiology and Public Health, Texas Department of State Health Services, San Antonio, USA
| | | | - Bialo Aladum
- Psychiatry, Ascension Borgess Hospital, Kalamazoo, USA
| | - Hakeem A Popoola
- Internal Medicine, Windsor University School of Medicine, Bassettere, KNA
| | - Gibson O Anugwom
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
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Langwerden RJ, van der Heijden PT, Soons PH, Derksen JJ, Vuijk R, Egger JI. An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability. CLINICAL NEUROPSYCHIATRY 2022; 19:335-346. [PMID: 36340276 PMCID: PMC9597642 DOI: 10.36131/cnfioritieditore20220509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). METHOD Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes. RESULTS The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD. CONCLUSIONS Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.
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Affiliation(s)
- Robbert J. Langwerden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands, Community-Based Research Institute, Florida International University, Miami, FL, USA,Corresponding Author Robbert J. Langwerden 11200 SW 8th Street, Miami, FL 33199, USA E-mail: robbert.langwerden@ donders.ru.nl Phone: (+1) 305 348 5388
| | - Paul T. van der Heijden
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands, Reinier van Arkel Mental Health Institute, ’s Hertogenbosch, The Netherlands
| | | | - Jan J.L. Derksen
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands, Faculty of Psychology and Educational Sciences, Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel, Belgium
| | - Richard Vuijk
- Sarr Autism Rotterdam, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Jos I.M. Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands, Vincent van Gogh Centres of Excellence for Neuropsychiatry, Venray, The Netherlands, Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
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Hidalgo N, Sjöwall D, Agius H, Byström C, Brar A, Borg J, Hirvikoski T. Psychoeducational group intervention for intellectually able adults with autism and their close relations (Prisma) - an open feasibility study. BMC Psychiatry 2022; 22:556. [PMID: 35986348 PMCID: PMC9389708 DOI: 10.1186/s12888-022-04134-4] [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] [Received: 12/15/2021] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) in adulthood is associated with severe impairments in functioning and poor health, while ASD is also affecting close relations. Accessible first-line interventions addressing the complex clinical needs and care coordination are lacking. METHODS This study investigated the feasibility and preliminary effects of a new psychoeducational intervention (Prisma) developed for intellectually able adults with ASD and their close relations in an outpatient setting. The manualized Prisma intervention consist of four weekly group sessions guided by trained group leaders and providing information about autism, support, and services. Feasibility was examined through treatment completion rate and group-level comparisons between intervention completers and non-completers (Student's t-test, Fisher's exact test, and Pearson's chi-squared test). Perceived treatment credibility was investigated by within-group comparisons of participant's self-ratings from pre-intervention to post-intervention, as well as by group leaders' ratings using an adjusted questionnaire. Treatment satisfaction was examined quantitatively regarding the session evaluations (Student's t-tests), as well as by a qualitative thematic analysis of participants' feedback. Preliminary efficacy was studied using paired t-tests (pre- and post-intervention). RESULTS Completion rate was 77% (n = 71 of the 92 adults with ASD) and 73% (n = 69 of the 94 close relations), respectively. Participants considered Prisma to be an acceptable intervention indicated by increases in treatment credibility and expectations from pre- to post-intervention. The group leaders reported treatment credibility in the same range as the participants. Both autistic adults and their close relations reported good treatment satisfaction for each session, while the qualitative thematic analysis indicated that Prisma could be improved by enhancing active participation. This participant feedback will be used to further improve the intervention for an upcoming RCT. Preliminary analyses of effects showed promising results with an increase in knowledge of ASD and some indications for improvements in relationship quality, mental health, quality of life, acceptance of diagnosis and burden of care. CONCLUSIONS Overall, results indicate that the Prisma is a feasible and acceptable first-line intervention in outpatient services. Randomized controlled trials are needed to further corroborate the evidence base of this novel intervention. TRIAL REGISTRATION Clinicaltrials.org NCT0446097, retrospectively registered July 8th 2020.
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Affiliation(s)
- Nathaniel Hidalgo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, R5:02, Stockholm, Sweden
- Region Stockholm, Stockholm, Sweden
| | - Douglas Sjöwall
- Department of Women's and Children's Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden
- Habilitation and Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Psychiatry Research, Center for Neurodevelopmental Disorders at KarolinskaInstitutet (KIND), CAP Research Center, Region StockholmGävlegatan 22B, SE-11330, Stockholm, Sweden
| | - Hanna Agius
- Department of Women's and Children's Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden
- Habilitation and Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Psychiatry Research, Center for Neurodevelopmental Disorders at KarolinskaInstitutet (KIND), CAP Research Center, Region StockholmGävlegatan 22B, SE-11330, Stockholm, Sweden
| | - Caroline Byström
- Psychiatric Services, Stockholm Health Care Services,, Region Stockholm, Stockholm, Sweden
- Modigo AB, Odengatan 69, 113 22, Stockholm, Sweden
| | - Annika Brar
- Habilitation and Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jacqueline Borg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, R5:02, Stockholm, Sweden
| | - Tatja Hirvikoski
- Department of Women's and Children's Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden.
- Habilitation and Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Center for Psychiatry Research, Center for Neurodevelopmental Disorders at KarolinskaInstitutet (KIND), CAP Research Center, Region StockholmGävlegatan 22B, SE-11330, Stockholm, Sweden.
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Chancel R, Miot S, Dellapiazza F, Baghdadli A. Group-based educational interventions in adolescents and young adults with ASD without ID: a systematic review focusing on the transition to adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-21. [PMID: 32889578 DOI: 10.1007/s00787-020-01609-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
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Affiliation(s)
- Raphael Chancel
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Stephanie Miot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHU de Montpellier, Université de Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier, France
| | - Florine Dellapiazza
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
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Bemmouna D, Weibel S, Kosel M, Hasler R, Weiner L, Perroud N. The utility of the autism-spectrum quotient to screen for autism spectrum disorder in adults with attention deficit/hyperactivity disorder. Psychiatry Res 2022; 312:114580. [PMID: 35523029 DOI: 10.1016/j.psychres.2022.114580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
The co-occurrence of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) has been reported to be highly prevalent in adults. However, very few studies have assessed the usefulness of screening instruments to detect this co-occurrence, particularly when screening for ASD in the context of ADHD. Our study aimed at assessing the utility of the autism-spectrum quotient (AQ) as a screening tool of ASD in a sample of 153 adults referred for ADHD assessment. Our results showed that the AQ is of limited use in this context as its positive predictive value was low (47%). Particularly, the more severe the attentional deficits the more likely individuals with ADHD were to be misclassified as having a co-occurring ASD based on the AQ. However, the "imagination" subscale of the AQ was able to discriminate those who met ASD criteria from those who did not, suggesting that targeting imagination impairments might be useful when assessing for the ADHD+ASD co-occurrence in clinical settings.
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Affiliation(s)
- Doha Bemmouna
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, Strasbourg 67000, France.
| | - Sébastien Weibel
- Inserm U1114, 1 Place de l'Hôpital, Strasbourg 67000, France; Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, Strasbourg 67000, France
| | - Markus Kosel
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospital of Geneva, 20 rue de Lausanne, Geneva 1201, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospital of Geneva, 20 rue de Lausanne, Geneva 1201, Switzerland
| | - Luisa Weiner
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, Strasbourg 67000, France; Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, Strasbourg 67000, France
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospital of Geneva, 20 rue de Lausanne, Geneva 1201, Switzerland
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