1
|
Ilen L, Feller C, Schneider M. Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1703-1718. [PMID: 37882494 PMCID: PMC11191376 DOI: 10.1177/13623613231204829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT Previous research has shown that autistic individuals report high levels of perceived stress and have an increased likelihood of developing mental health difficulties. Increase in individuals' negative emotions in relation to perceived stress (i.e. affective reactivity to stress) is a known risk factor for mental health difficulties. In this study, we investigated perceived daily stress and affective reactivity to stress in autistic (n = 39, age = 18.4) and non-autistic (n = 55, age = 18.1) adolescents and young adults. We used the ecological momentary assessment, a technique that allows to assess individuals repeatedly in their daily life using their smartphone. Moreover, participants filled a questionnaire to evaluate the strategies they use to regulate emotions when faced with difficulties. Finally, a clinical interview and a parent-report questionnaire were used to assess mental health symptoms. Autistic youth reported higher levels of perceived daily stress compared with non-autistic peers. Moreover, they showed increased affective reactivity to stress related to their daily activities. Autistic participants reported more emotion regulation difficulties (e.g. more repetitive thinking of difficulties) compared with non-autistic participants. Difficulties in emotion regulation increased negative emotions in relation to stress and might contribute to the severity of mental health symptoms. We conclude that adolescents and young adults with autism report high perceived stress in their daily lives. To minimize the negative impact of stress and the development of mental health symptoms, people supporting autistic young people could focus on stress management skills and the strategies that the youth use to manage emotions.
Collapse
|
2
|
Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population Level Mental Health Diagnoses for Youth with Intellectual/Developmental Disabilities Compared to Youth without Intellectual/Developmental Disabilities. Res Child Adolesc Psychopathol 2024; 52:1147-1156. [PMID: 38329685 DOI: 10.1007/s10802-024-01174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
There is evidence in the literature that youth with intellectual/developmental disabilities (IDD) experience mental health issues to a greater extent compared to youth without IDD. In addition, transition from pediatric to adult services may be a period of increased anxiety and mental health problems for these youth. This study used a retrospective cohort design using population level administrative health data to compare mental health diagnoses between youth with IDD and youth without IDD; particularly examining the period when youth transition from pediatric health services to adult health services. In addition, this study compared the mental health of youth with various types of IDD (Down syndrome, autism, fetal alcohol syndrome and other rarer diagnoses). Results showed that at the population level youth with IDD have greater odds of anxiety/depression or psychotic illness than youth without IDD. Adjusted odds of anxiety/depression or psychotic illness also varied with age, income level, sex, and type of IDD. Youth with fetal alcohol syndrome had the greatest odds of both anxiety/depression and a psychotic illness. Odds of anxiety/depression increased from age 15-19 years old. Odds of a psychotic illness increased from age 15 to age 24 years old.
Collapse
Affiliation(s)
- Sandra Marquis
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ON, M6J 1H4, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| |
Collapse
|
3
|
Ridgway K, Macmillan C, Demmer DH, Hooley M, Hedley D, Westrupp E, Stokes MA. Subjective wellbeing of autistic adolescents and young adults: A cross sectional study. Autism Res 2024; 17:1175-1186. [PMID: 38682234 DOI: 10.1002/aur.3139] [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: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
Subjective wellbeing (SWB) represents an individual's perception of wellness that is supported by homeostatic mechanisms. These mechanisms are proposed to be maintained by low negative affect and high positive affect, although less is known about these mechanisms and SWB in autism. The current cross-sectional study aimed to compare patterns of positive affect, negative affect (Positive Affect and Negative Affect Scale), and SWB (Personal Wellbeing Index-School Children) between autistic (n = 53) and non-autistic (n = 49) individuals aged 10-22 years (Mage = 13.97, SD = 3.13). Between-group t-tests revealed that compared with same-age peers, autistic participants scored lower SWB overall (p < 0.001). In both groups average SWB scores fell into the higher range, however, autistic participants were three-times more likely to fall below this range when compared to non-autistic participants. Negative affect had a higher intercept in the autistic sample, but no difference in slopes were observed. A hierarchical multiple regression revealed that diagnosis, positive affect, and negative affect significantly predicted SWB in our sample. Between-group t-tests found no significant difference in positive affect or negative affect across age between the autistic and non-autistic samples. In autistic participants, positive affect increased across age as SWB decreased, whilst negative affect remained stable, a pattern inconsistent with homeostatic SWB. The current study is overall consistent with the homeostatic explanation for SWB within autism; however, we identified potential differences between autistic and non-autistic participants in the contribution of positive affect and negative affect to homeostatic protect mood across development.
Collapse
Affiliation(s)
- Kathryn Ridgway
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
| | - Caitlin Macmillan
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David H Demmer
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
| | - Merrilyn Hooley
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Elizabeth Westrupp
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
| | - Mark A Stokes
- School of Psychology, Healthy Autistic Life Lab, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
4
|
Song W, McLean KJ, Gifford J, Kissner H, Sipe R. Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06401-7. [PMID: 38771506 DOI: 10.1007/s10803-024-06401-7] [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] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. OBJECTIVE The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. PARTICIPANTS AND SETTING Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. METHODS Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. RESULTS Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. CONCLUSION These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.
Collapse
Affiliation(s)
- Wei Song
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Kiley J McLean
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Jordan Gifford
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Hailey Kissner
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Rosalind Sipe
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| |
Collapse
|
5
|
Dincel M, Karayagmurlu A. An Investigation of Dissociative Symptoms and Related Factors in Autistic Adolescents. J Autism Dev Disord 2024:10.1007/s10803-024-06374-7. [PMID: 38743151 DOI: 10.1007/s10803-024-06374-7] [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: 04/20/2024] [Indexed: 05/16/2024]
Abstract
Despite exposure to trauma and adverse life events being frequently reported in Autism Spectrum Disorder (ASD), few studies have examined the relationship between these factors and dissociative symptoms in the autistic population. The aim of the study is to investigate symptoms of dissociation in autistic adolescents, and to explore factors that could be associated with dissociative symptoms in ASD. This cross-sectional study involved 59 autistic adolescents between 12 and 18 years old, with the mean age of 14.3 ± 1.8. Dissociation, autism characteristics, childhood traumas, peer bullying, and Post-Traumatic Stress Disorder (PTSD) symptoms were assessed using the Adolescent Dissociative Experiences Scale (ADES), the Childhood Autism Rating Scale (CARS), the Childhood Trauma Questionnaire (CTQ), the Nine-Item Child-Adolescent Bullying Screen (CABS-9), and the Child Posttraumatic Stress Reaction Index (CPTS-RI), respectively. Results from the ADES revealed that 12.5% of the participants scored above the threshold for dissociative disorders. In the linear regression model constructed to evaluate factors associated with dissociative symptoms, an increase in dissociative symptoms was statistically significantly associated with an increase in the total CTQ score (p = 0.002) and age (p = 0.006). The findings of the study indicate that dissociative symptoms may occur in autistic adolescents. It is suggested that dissociative symptoms observed in autistic adolescents may particularly be associated with childhood traumas and increasing age. Further research into dissociative symptoms in ASD is warranted, requiring larger sample sizes, specialized measurement scales, and structured interviews.
Collapse
Affiliation(s)
- Melodi Dincel
- Department of Child and Adolescent Psychiatry, Midyat State Hospital, Midyat, Mardin, Turkey.
| | - Ali Karayagmurlu
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
6
|
Kildahl AN, Helverschou SB. Post-traumatic stress disorder and experiences involving violence or sexual abuse in a clinical sample of autistic adults with intellectual disabilities: Prevalence and clinical correlates. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1075-1089. [PMID: 37609889 PMCID: PMC11067401 DOI: 10.1177/13623613231190948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
LAY ABSTRACT Post-traumatic stress disorder is a mental health disorder that may be triggered by the experience of events perceived as terrifying or overwhelming. Examples of such events include being the victim of violence or sexual abuse. Compared with other people, autistic people have increased risk of being exposed to violence or sexual abuse. In addition, autistic people may be more vulnerable to developing post-traumatic stress disorder following such exposure. However, knowledge is limited concerning the prevalence of experiences involving violence and sexual abuse, and post-traumatic stress disorder, in autistic people with co-occurring intellectual disabilities. Detection of these experiences, and identification of post-traumatic stress disorder, may be challenging in these individuals, and previous research indicates that post-traumatic stress disorder symptoms may be overlooked or misinterpreted. In this study, we examined prevalence of post-traumatic stress disorder, violence and sexual abuse in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only 3.4% were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of 'challenging' behaviours. These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment, and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.
Collapse
|
7
|
Nelson CA, Sullivan E, Engelstad AM. Annual Research Review: Early intervention viewed through the lens of developmental neuroscience. J Child Psychol Psychiatry 2024; 65:435-455. [PMID: 37438865 DOI: 10.1111/jcpp.13858] [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: 05/24/2023] [Indexed: 07/14/2023]
Abstract
The overarching goal of this paper is to examine the efficacy of early intervention when viewed through the lens of developmental neuroscience. We begin by briefly summarizing neural development from conception through the first few postnatal years. We emphasize the role of experience during the postnatal period, and consistent with decades of research on critical periods, we argue that experience can represent both a period of opportunity and a period of vulnerability. Because plasticity is at the heart of early intervention, we next turn our attention to the efficacy of early intervention drawing from two distinct literatures: early intervention services for children growing up in disadvantaged environments, and children at elevated likelihood of developing a neurodevelopmental delay or disorder. In the case of the former, we single out interventions that target caregiving and in the case of the latter, we highlight recent work on autism. A consistent theme throughout our review is a discussion of how early intervention is embedded in the developing brain. We conclude our article by discussing the implications our review has for policy, and we then offer recommendations for future research.
Collapse
Affiliation(s)
- Charles A Nelson
- Department of Pediatrics and Neuroscience, Harvard Medical School, Boston, MA, USA
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Eileen Sullivan
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Anne-Michelle Engelstad
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| |
Collapse
|
8
|
Li ST, Chien WC, Chung CH, Tzeng NS. Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: a nation-wide cohort study in Taiwan. Front Psychiatry 2024; 15:1329836. [PMID: 38356908 PMCID: PMC10864464 DOI: 10.3389/fpsyt.2024.1329836] [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: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject. Methods Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD. Results Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001). Discussion This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.
Collapse
Affiliation(s)
- Sung-Tao Li
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
9
|
Hickey EJ, DaWalt LS, Bolt D, Hong J, Song J, Lounds Taylor J, Mailick MR. Impact of the Great Recession on Adults With Autism and Their Mothers. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:26-40. [PMID: 38147887 DOI: 10.1352/1944-7558-129.1.26] [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: 06/27/2022] [Accepted: 04/04/2023] [Indexed: 12/28/2023]
Abstract
Autistic individuals and their families are at risk for poor outcomes in employment and mental health and may be vulnerable to long-term effects of broader societal conditions. The aim of the current longitudinal study was to understand the impact of the Great Recession of 2007-2009 on autistic individuals and their mothers (N = 392). Hierarchical linear modeling (HLM) results indicated that problem behavior of autistic adults increased in the years following the recession. The rate at which autistic individuals moved away and lived separately from their mothers also slowed during the recession. Mothers experienced significantly higher levels of depressive symptoms postrecession, compared to prerecession. In many other respects, the autistic individuals and their mothers did not experience negative outcomes, suggesting resilience and a strong safety net. These included the physical health and vocational/employment status of the autistic adults and their mothers. Results point to specific areas of vulnerability of autistic individuals and their mothers during the economic downturn, as well as a broad pattern of resilience in these families.
Collapse
Affiliation(s)
- Emily J Hickey
- Emily J. Hickey, Leann Smith DaWalt, Daniel Bolt, Jinkuk Hong, and Jieun Song, University of Wisconsin-Madison
| | - Leann Smith DaWalt
- Emily J. Hickey, Leann Smith DaWalt, Daniel Bolt, Jinkuk Hong, and Jieun Song, University of Wisconsin-Madison
| | - Daniel Bolt
- Emily J. Hickey, Leann Smith DaWalt, Daniel Bolt, Jinkuk Hong, and Jieun Song, University of Wisconsin-Madison
| | - Jinkuk Hong
- Emily J. Hickey, Leann Smith DaWalt, Daniel Bolt, Jinkuk Hong, and Jieun Song, University of Wisconsin-Madison
| | - Jieun Song
- Emily J. Hickey, Leann Smith DaWalt, Daniel Bolt, Jinkuk Hong, and Jieun Song, University of Wisconsin-Madison
| | | | | |
Collapse
|
10
|
Gibbs V, Hudson JL, Pellicano E. Poly-victimization of autistic adults: An investigation of individual-level correlates. Autism Res 2023; 16:2336-2349. [PMID: 37737378 DOI: 10.1002/aur.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
Autistic people experience high rates of violence and victimization which is largely due to structural injustices, including stigma and social attitudes. Identifying and addressing systemic and structural factors is vitally important, however effecting change in embedded social structures is likely to take some time, even with concerted efforts. In the meantime, it is important to understand whether there are other individual-level factors that may assist in developing preventative and protective strategies for autistic people. The current study investigated the role of individual-level risk factors in the victimization of autistic people. Specifically, we examined whether characteristics that are common among autistic people that is, lower social competence, higher compliance and emotion regulation difficulties or more ADHD features (inattention, impulsiveness and hyperactivity) were associated with poly-victimization in a community sample of 228 adults (118 autistic, 110 non-autistic). Our results show that only ADHD features were predictive of poly-victimization once socio-demographic background variables (age, sexual orientation) were adjusted for. Group status was not a significant predictor in the model and there were no interaction effects between any of the characteristics and group status. These findings suggest that, regardless of whether a person is autistic, ADHD features may place individuals at higher risk of experiencing multiple forms of violence in adulthood. Further research using longitudinal designs and larger, diverse samples is needed. Furthermore, the regression model only accounted for about one-third of the variance in poly-victimization which highlights the importance of looking beyond individual-level risk factors to structural and systemic factors that contribute to disproportionate victimization of autistic people.
Collapse
Affiliation(s)
- Vicki Gibbs
- Macquarie School of Education, Macquarie University, Macquarie Park, New South Wales, Australia
| | | | - Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Macquarie Park, New South Wales, Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
11
|
Bertelli MO, Forte L, Bianco A. Updates in the care of youths with intellectual disability and autism spectrum disorder. Curr Opin Psychiatry 2023; 36:455-460. [PMID: 37781976 DOI: 10.1097/yco.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Since the turn of the new millennium, care for people with intellectual disability/intellectual developmental disorders (IDD) and/or autism spectrum disorder (ASD) has drawn increasing attention because of the continuous prevalence increase of these two conditions, the high health vulnerability, especially mental vulnerability, and the crucial role of care provision in the setting of continued deinstitutionalization and the shift to community care. The present review addresses the main issues related to mental healthcare in youth with IDD and/or ASD with a specific focus on adolescence and transition to adulthood. RECENT FINDINGS Despite the existence of specific recommendations, persons with IDD/ASD lack access to quality mental healthcare within communities, receive inadequate diagnosis and intervention, including medication overuse as well as ineffective residential, educational, employment, financial, and social support services. The lack of a unified care system that provides services across all domains and life ages may be the cause of users' perceptions and experiences of inefficiencies. SUMMARY The scientific community seems to converge on that care should be provided in accordance with principles of interdisciplinarity, life-span view, precision, personalization, and participation. Quality of life appears to be an ideal conceptual reference for care planning and outcome evaluation.
Collapse
Affiliation(s)
- Marco O Bertelli
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
| | - Luciana Forte
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
| |
Collapse
|
12
|
Bortoletto R, Bassani L, Garzitto M, Lamberti M, Simonati A, Darra F, Bhattacharyya S, Comacchio C, Balestrieri M, Arcangeli D, Colizzi M. Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9-year chart review study. Autism Res 2023; 16:2139-2149. [PMID: 37929657 DOI: 10.1002/aur.3042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre-existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty-nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9-year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)-10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between-group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = -1.962; χ2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis-inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.
Collapse
Affiliation(s)
- Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lorenzo Bassani
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Marco Lamberti
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Alessandro Simonati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Francesca Darra
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carla Comacchio
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Donatella Arcangeli
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
13
|
Bemmouna D, Weiner L. Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization. Front Psychiatry 2023; 14:1238116. [PMID: 37840783 PMCID: PMC10570453 DOI: 10.3389/fpsyt.2023.1238116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.
Collapse
Affiliation(s)
- Doha Bemmouna
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
| | - Luisa Weiner
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- Département de Psychiatrie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| |
Collapse
|
14
|
Termine C, Galli V, Dui LG, Berlusconi V, Lipari R, Lunardini F, Ferrante S. Autism in Preschool-Aged Children: The Effects of COVID-19 Lockdown. J Autism Dev Disord 2023:10.1007/s10803-023-06078-4. [PMID: 37540405 DOI: 10.1007/s10803-023-06078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
The COVID-19 lockdown affected children, especially those with autism spectrum disorder, due to the disruption in rehabilitation and educational activities. We conducted a cross-sectional study of 315 preschool-aged children, 35 of which had autism, to investigate this impact. A questionnaire was administered to explore socio-demographic status, familiar/home environment, and COVID-19 exposure. The clinical features of autistic subjects were also examined. Seven variables were considered to describe the effect of pandemic: Remote learning, Behavior changes, Home activities, Sleep habits, Night awakenings, Physical activity, Information about the virus. The lockdown had a significant impact on Remote learning, Behavior changes, and Information about the virus in participants with autism. Moreover, we found a worsening in repetitive movements, echolalia, restricted interests, and aggressive behaviors.
Collapse
Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Piazza Biroldi 19, 21100, Varese, Italy
- Department of Maternal and Child Health, Del Ponte Hospital, Varese, Italy
| | - Vera Galli
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Piazza Biroldi 19, 21100, Varese, Italy.
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Linda Greta Dui
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Valentina Berlusconi
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Piazza Biroldi 19, 21100, Varese, Italy
| | - Rossella Lipari
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Piazza Biroldi 19, 21100, Varese, Italy
| | - Francesca Lunardini
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Hogendoorn E, Hartman CA, Burke SM, van Dijk MWG, Rosmalen JGM. Longitudinal relations between autistic-like features and functional somatic symptoms in adolescence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1690-1701. [PMID: 36588286 PMCID: PMC10375000 DOI: 10.1177/13623613221143874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract Autistic-like features and functional somatic symptoms (FSS) frequently co-occur. It remains unknown how autistic-like features and FSS affect each other and develop throughout adolescence. This study examined reciprocal relations between autistic-like features and FSS in adolescence. Participants were 2772 adolescents (52.5% male) from the Tracking Adolescents’ Individual Lives Survey population and clinical cohort. Data from four waves were included, covering the ages between 11 and 19 years. Autistic-like features were measured using the Children’s Social Behavior Questionnaire. FSS were assessed using the Youth Self Report and Adult Self Report, respectively. Using the random intercept cross-lagged panel model, a stable positive, moderately strong between-persons association was found between autistic-like features and FSS. No within-persons reciprocal effects from wave to wave were observed. Secondary analyses revealed a consistent relation with FSS for three different domains of autistic-like features (social and communication behaviors, repetitive behaviors, and self-regulatory behaviors), and highly similar interrelations in a subsample of adolescents with a clinical autism spectrum disorder diagnosis. In conclusion, the co-occurrence between autistic-like features and FSS is stable throughout adolescence. Clinicians working with adolescents with autistic-like features should be alert to the presence FSS, and vice versa.
Collapse
|
17
|
Hernández-González O, Fresno-Rodríguez A, Spencer-Contreras RE, Tárraga-Mínguez R, González-Fernández D, Sepúlveda-Opazo F. Research Mapping of Trauma Experiences in Autism Spectrum Disorders: A Bibliometric Analysis. Healthcare (Basel) 2023; 11:healthcare11091267. [PMID: 37174809 PMCID: PMC10178446 DOI: 10.3390/healthcare11091267] [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: 02/21/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The number of research related to traumatic experiences in people with autism spectrum disorder (ASD) has grown exponentially, yet there are no bibliometric studies in this field. This article aimed to analyze the literature related to trauma and ASD published in Web of Science (WoS). Papers on trauma and ASD were retrieved from the WoS. Analysis and visualization of selected documents were performed using MS Excel (v16.0), VOS viewer (version 1.6.15), and R package (Biblioshiny, version 2.0). A total of 147 articles were included in this study. The results showed that production has been increasing over the last few years. Among the countries identified, the USA published the largest number of articles. Arvid Nikolai Kildahl, Sissel Berge Helverschou, and Liliana Dell'Osso were the authors with the most number of publications on this topic, and Autism was the most productive journal. The main research topics associated with ASD were post-traumatic stress and traumatic experiences in childhood. This bibliometric study contributes to understanding research trends on trauma and ASD by evaluating relevant publications in the last decades. The results of this bibliometric analysis can serve as a basis and orientation for new studies.
Collapse
Affiliation(s)
- Osvaldo Hernández-González
- Faculty of Psychology and Institute of Humanistic Studies Juan Ignacio Molina, Universidad de Talca, Talca 3480094, Chile
| | | | | | - Raúl Tárraga-Mínguez
- Department of Education, School Management, Faculty of Teacher Training, University of Valencia, 46010 Valencia, Spain
| | | | | |
Collapse
|
18
|
Secci I, Petigas L, Cuenod A, Klauser P, Kapp C, Novatti A, Armando M. Case report: Treatment-resistant depression, multiple trauma exposure and suicidality in an adolescent female with previously undiagnosed Autism Spectrum Disorder. Front Psychiatry 2023; 14:1151293. [PMID: 37181890 PMCID: PMC10169628 DOI: 10.3389/fpsyt.2023.1151293] [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: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
High rates of co-occurring depression are commonly reported in youth with Autism Spectrum Disorder (ASD), especially in individuals without intellectual disability (ID). Depression in ASD undermines adaptive behavior and is associated with a higher risk of suicidality. Females with ASD may be particularly vulnerable due to their greater use of camouflaging strategies. Indeed, in comparison to males, ASD is underdiagnosed in females, despite higher rates of internalizing symptoms and suicidality. Trauma exposure may also play a role in the development of depressive symptoms in this population. Moreover, evidence for effective treatments of depression in autistic youth are lacking, with ASD individuals frequently experiencing low efficacy and side effects. We present the case of an adolescent female with previously undiagnosed ASD without ID, admitted for active suicidal plans and a treatment-resistant depression (TRD), occurred after a COVID-19 lockdown in the context of cumulative exposure to stressful life events. Comprehensive clinical assessments performed at intake confirmed severe depression with suicidality. Intensive psychotherapy and different changes in medications were carried out (SSRI, SNRI, SNRI + NaSSA, SNRI + aripiprazole), all of which were ineffective, with persistent suicidal thoughts, often requiring intensive individual monitoring. The patient was finally successfully treated with lithium augmentation of fluoxetine, with no side effects. During hospitalization she was also evaluated by an ASD specialized center, where a diagnosis of ASD was made according to the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) scores, as well as to clinical judgment of a senior psychiatrist. The present case report shows that clinicians should not overlook undiagnosed autism as a possible cause of TRD, especially in females without ID, where higher rates of under diagnosis may be in part related to their greater use of camouflage. It also suggests that ASD underdiagnosis and resulting unmet needs may be involved in vulnerability to stressful experiences, depression, and suicidality. Furthermore, it shows the complexity of providing care to TRD in youth with autism, suggesting that an augmentation therapy with lithium, a commonly recommended therapeutic strategy for refractory depression in typically developing samples, may also be effective in this population.
Collapse
Affiliation(s)
- Ilaria Secci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Lucie Petigas
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Alexandra Cuenod
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Klauser
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Carole Kapp
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Audrey Novatti
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Marco Armando
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
19
|
Mukherjee S, Beresford B. Factors influencing the mental health of autistic children and teenagers: Parents' observations and experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231158959. [PMID: 36922430 PMCID: PMC10576903 DOI: 10.1177/13623613231158959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Autistic people are more likely to experience mental health difficulties compared to neurotypical people. It is very important that we understand what increases the risk for mental health difficulties, and what helps to protect against them. So far, research on this for children and young people has only investigated a small number of factors and these have been chosen by researchers and clinicians. This study took a different approach in which parents' expertise in their children was recognised. Parents were asked to tell the story of their autistic teenagers' mental health from diagnosis in early childhood through to the present, and to explain the 'theories' they developed about what affected their child's mental health - positively and negatively - and how. Parents believed a wide range of factors played a role. These include: (1) aspects of their child (e.g. their autistic traits, intelligence); (2) aspects of their surroundings (e.g. the efforts parents make to prevent and respond to their child's difficulties, features of the school they attend, availability of social activities); (3) changes their child experienced growing up (e.g. puberty, awareness of being autistic); and (4) life events involving loss and separation. Many of the factors parents identified as important have received little or no research attention to date. The findings suggest issues that should be considered in future research and reveal ways that support for parents and autistic children and teenagers can be improved.
Collapse
|
20
|
Heselton GA, Rempel GR, Nicholas DB. “Realizing the problem wasn’t necessarily me”: the meaning of childhood adversity and resilience in the lives of autistic adults. Int J Qual Stud Health Well-being 2022; 17:2051237. [PMID: 35297725 PMCID: PMC8933012 DOI: 10.1080/17482631.2022.2051237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Gabrielle A. Heselton
- Faculty of Health Disciplines (FHD), Athabasca University, Athabasca, Alberta, Canada
| | - Gwen R. Rempel
- Faculty of Health Disciplines (FHD), Athabasca University, Athabasca, Alberta, Canada
| | - David B. Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
21
|
Wilkinson E, Vo LTV, London Z, Wilson S, Bal VH. Parent-Reported Strengths and Positive Qualities of Adolescents and Adults with Autism Spectrum Disorder and/or Intellectual Disability. J Autism Dev Disord 2022; 52:5471-5482. [PMID: 35064451 PMCID: PMC9304434 DOI: 10.1007/s10803-021-05405-x] [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] [Accepted: 12/12/2021] [Indexed: 12/19/2022]
Abstract
Despite increasing attention to understanding strengths in those on the autism spectrum, few studies have explored this in older individuals. The present study provides a qualitative analysis of parent-reported strengths and positive qualities of 68 15-30-year-olds with autism and/or intellectual disability (ID). Most parents (97%) reported at least one positive quality. Themes were consistent with previous studies; Personality characteristics (82%) and Sociability (53%) were reported most frequently. A Work Ethic/Motivation category not previously reported emerged. Autistic individuals (with/without ID) were more likely than those with ID-only to have a Specific Skill. Findings highlight the importance of recognizing strengths of autistic adults. Research is needed to understand how to best leverage positive qualities to promote goal achievement and quality of life.
Collapse
Affiliation(s)
- Ellen Wilkinson
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Le Thao Vy Vo
- Western New England University, Springfield, MA, USA
| | - Zoe London
- School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Sherri Wilson
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Vanessa H Bal
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA.
| |
Collapse
|
22
|
Tomaszewski B, Klinger LG, Pugliese CE. Self-Determination in Autistic Transition-Aged Youth without Intellectual Disability. J Autism Dev Disord 2022; 52:4067-4078. [PMID: 34536165 PMCID: PMC8930783 DOI: 10.1007/s10803-021-05280-6] [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: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Self-determination refers to an individual's capacity and opportunities to act as a causal agent in their own lives to make choices, decisions, and set goals. The current study examined self- and parent-reports of the AIR Self-Determination Scale in transition-aged autistic youth (Based on stakeholder preferences, we use identity-first(autistic) or neutral language (on the autism spectrum) (Bottema-Beutel in JAMA 3:18-29, 2020)). Autistic youth completed depression and executive function measures, and parents rated their child's social-communication and executive function difficulties. Despite differences between youth and parent reports, both youth and their parents reported lower self-determination skills (capacity) than opportunities to practice self-determined behaviors. Both depression and executive function skills were related to self-determination capacity, highlighting potential intervention targets for transition-aged youth to facilitate increased self-determination and potentially improved adult outcomes.
Collapse
Affiliation(s)
- Brianne Tomaszewski
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, CB#7180, Chapel Hill, NC, 27599-7180, USA.
| | - Laura G Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, CB#7180, Chapel Hill, NC, 27599-7180, USA
| | - Cara E Pugliese
- Center for Autism Spectrum Disorders, Division of Pediatric Neuropsychology, Children's Research Institute, Children's National Hospital, Washington, USA
- Department of Psychiatry, Behavioral Sciences & Pediatrics, The George Washington University School of Medicine, 15245 Shady Grove Rd., Suite 350, Rockville, MD, 20850, USA
| |
Collapse
|
23
|
van Diest C, Leoni M, Fisher N, Spain D. Using EMDR With Autistic Clients: How Do Therapists Adapt? JOURNAL OF EMDR PRACTICE AND RESEARCH 2022. [DOI: 10.1891/emdr-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autistic people commonly experience co-morbid mental health conditions, including post-traumatic stress disorder (PTSD), anxiety, and low mood. General consensus is that autistic people can benefit from evidence-based psychological therapies, with the acceptability and effectiveness of eye movement desensitization and reprocessing (EMDR) therapy becoming a growing area of interest. One hundred and three EMDR therapists were asked if and how they adapt the standard EMDR protocol to make the process and content more tailored to the needs and preferences of autistic people. We analyzed the qualitative responses of participants to these questions, including barriers and adaptations to all eight phases of the EMDR standard protocol. Overall, therapists emphasized the need for flexibility and responsiveness to the individual client, and the importance of autism-specific knowledge and autism-informed clinical supervision. Implications and future directions are discussed.
Collapse
|
24
|
Ng-Cordell E, Rai A, Peracha H, Garfield T, Lankenau SE, Robins DL, Berkowitz SJ, Newschaffer C, Kerns CM. A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma. Front Psychiatry 2022; 13:825008. [PMID: 35911211 PMCID: PMC9329569 DOI: 10.3389/fpsyt.2022.825008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure. Objectives To describe the range of coping strategies autistic individuals use following traumatic events. Methods Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes. Results Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors. Conclusions Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.
Collapse
Affiliation(s)
- Elise Ng-Cordell
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Anika Rai
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Hira Peracha
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Garfield
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Diana L. Robins
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | | | - Craig Newschaffer
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Connor M. Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| |
Collapse
|
25
|
McQuaid GA, Weiss CH, Said AJ, Pelphrey KA, Lee NR, Wallace GL. Increased perceived stress is negatively associated with activities of daily living and subjective quality of life in younger, middle, and older autistic adults. Autism Res 2022; 15:1535-1549. [PMID: 35790082 PMCID: PMC9545671 DOI: 10.1002/aur.2779] [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] [Received: 01/21/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Few studies have examined self‐reported perceived stress in autistic adults. Existing studies have included relatively small, predominantly male samples and have not included older autistic adults. Using a large autistic sample (N = 713), enriched for individuals designated female at birth (59.3%), and spanning younger, middle, and older adulthood, we examined perceived stress and its associations with independence in activities of daily living and subjective quality of life (QoL). Perceived stress for autistic adults designated male or female at birth was compared to their same birth‐sex counterparts in a general population sample. In addition, within the autistic sample, effects of sex designated at birth, age, and their interaction were examined. Regression modeling examined associations between perceived stress and independence in activities of daily living and domains of subjective QoL in autistic adults, after controlling for age, sex designated at birth, and household income. Autistic adults reported significantly greater perceived stress than a general population comparison sample. Relative to autistic adults designated male at birth, those designated female at birth demonstrated significantly elevated perceived stress. Perceived stress contributed significantly to all regression models, with greater perceived stress associated with less independence in activities of daily living, and poorer subjective QoL across all domains—Physical, Psychological, Social, Environment, and Autism‐related QoL. Findings are contextualized within the literature documenting that autistic individuals experience elevated underemployment and unemployment, heightened rates of adverse life events, and increased exposure to minority stress.
Collapse
Affiliation(s)
- Goldie A. McQuaid
- Department of Psychology George Mason University Fairfax Virginia USA
| | - Colin H. Weiss
- Department of Psychology George Mason University Fairfax Virginia USA
| | - Alex Job Said
- Department of Speech, Language, and Hearing Sciences The George Washington University Washington District of Columbia USA
| | - Kevin A. Pelphrey
- Department of Neurology University of Virginia School of Medicine Charlottesville Virginia USA
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences Drexel University Philadelphia Pennsylvania USA
| | - Gregory L. Wallace
- Department of Speech, Language, and Hearing Sciences The George Washington University Washington District of Columbia USA
| |
Collapse
|
26
|
Viola TW, Nunes ML. Social and environmental effects of the COVID-19 pandemic on children. J Pediatr (Rio J) 2022; 98 Suppl 1:S4-S12. [PMID: 34571018 PMCID: PMC8463108 DOI: 10.1016/j.jped.2021.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to review the literature, summarizing the existing evidence on the effects of the pandemic on children, adolescents and parents, with an emphasis on the psychological, emotional, and sleep quality consequences. SOURCE OF DATA Empirical studies identified in the following databases: MEDLINE, ISI Web of Knowledge/Web of Science, and preprint servers. SYNTHESIS OF DATA The findings point to a wide range of consequences for children and adolescents resulting from the COVID-19 pandemic, which mainly includes an increase in depressive mood symptoms. There is also an increase in anxiety symptoms, suicidal ideation, as well as potential delays in language and motor development resulting from deprivation of social interaction and the closing of schools. These effects are more severe due to previous neuropsychiatric conditions. For parents, there is an increase in anxiety, depressive and post-traumatic symptoms, which are more accentuated in those who suffered socioeconomic damage due to the pandemic. There was an important increase in situations of violence towards children by parents and caregivers during the pandemic. Also, changes in routine and fear of the pandemic have negatively impacted sleep quality, globally. CONCLUSIONS It is noteworthy that most studies published to date used a cross-sectional design and applied online screening questionnaires. The few studies with a longitudinal design suggest that these changes may have been transitory and more prevalent at the beginning of the pandemic.
Collapse
Affiliation(s)
- Thiago Wendt Viola
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Laboratório de Neurociência Cognitiva do Desenvolvimento (DCNL) and Instituto do Cérebro (InsCer), Porto Alegre, RS, Brazil.
| | - Magda Lahorgue Nunes
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Núcleo de Neurociências and Instituto do Cérebro (InsCer), Porto Alegre, RS, Brazil
| |
Collapse
|
27
|
Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. Traumatic life experiences and post-traumatic stress symptoms in middle-aged and older adults with and without autistic traits. Int J Geriatr Psychiatry 2022; 37. [PMID: 34994472 DOI: 10.1002/gps.5669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Research with younger adults has begun to explore associations between autism/autistic traits and vulnerability to Post Traumatic Stress Disorder (PTSD). Large scale studies and/or examination of age-effects have not been conducted. METHODS Adults aged 50 years+ from the PROTECT study (n = 20,220) completed items about current and childhood socio-communicative difficulties characteristic of autism. Approximately 1% (n = 251) endorsed high autistic traits, henceforth the Autism Spectrum Traits (AST) group. Differences between the AST and an age-and sex-matched "Comparison Older Adults" (COA; n = 9179) group were explored for lifetime traumatic experiences and current symptoms of PTSD, depression, and anxiety. RESULTS Almost 30% of the AST group, compared to less than 8% of the COA, reported severe trauma in childhood/adulthood, including emotional, physical or sexual abuse. Elevated current PTSD symptoms were reported by AST compared to COA. An interaction was observed between autistic traits and trauma severity; the effect of level of trauma on PTSD symptoms was significantly greater for AST versus COA participants. This interaction remained significant when controlling for current depression and anxiety symptoms. CONCLUSIONS The findings suggest that high autistic traits may increase the likelihood of experiencing trauma across the lifespan, and the impact of severe trauma on PTSD symptoms. Older adults with high (vs. low) autistic traits may be at greater risk of experiencing PTSD symptoms in latter life. Future research should test whether the pattern of results is similar for diagnosed autistic adults.
Collapse
Affiliation(s)
- Gavin R Stewart
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Hampshire
- Department of Medicine, Imperial College London, London, UK
| | | | - Francesca Happé
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
28
|
Kerns CM, Lankenau S, Shattuck PT, Robins DL, Newschaffer CJ, Berkowitz SJ. Exploring potential sources of childhood trauma: A qualitative study with autistic adults and caregivers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1987-1998. [PMID: 35068176 PMCID: PMC9597164 DOI: 10.1177/13623613211070637] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The stressors autistic individuals encounter and experience as traumatic may vary
from non-autistics. We conducted a qualitative study to identify potential
sources of trauma for autistic individuals and evaluate correspondence with a
standard measure. We enrolled autistic adults (N = 14) and
caregivers (N= 15) with varied adversities, levels of
functioning, and socio-demographics. Participants completed standard measures of
autism, traumatic exposures and stress, and qualitative interviews, which were
submitted to thematic analysis. A wide range of experiences were described as
traumatic. Whereas some reflected traditional traumas (e.g. maltreatment) and
forms of social marginalization, others reflected conflicts between autistic
characteristics and the environment (e.g. sensory trauma). All adults and
caregivers described sources of trauma in interviews not captured by
standardized measures. Varied stressful experiences, many not detected by a
standardized measure, may have a traumatic effect on autistic individuals.
Whereas some reflect commonly recognized trauma sources, others may reflect
particular vulnerabilities for autistic individuals. Results have implications
for assessing traumatic events and understanding their contribution to mental
health inequities in the autistic population.
Collapse
|
29
|
Carter Leno V, Wright N, Pickles A, Bedford R, Zaidman-Zait A, Kerns C, Mirenda P, Zwaigenbaum L, Duku E, Bennett T, Georgiades S, Smith I, Vaillancourt T, Szatmari P, Elsabbagh M. Exposure to family stressful life events in autistic children: Longitudinal associations with mental health and the moderating role of cognitive flexibility. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1656-1667. [PMID: 36113122 PMCID: PMC9483693 DOI: 10.1177/13623613211061932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mental health problems are prevalent in autistic youth, but the underpinning
mechanisms are not well explored. In neurotypical youth, stressful life events
are an established risk factor for mental health problems. This study tested
longitudinal bidirectional associations between family-level stressful life
events and mental health problems and whether these were moderated by cognitive
flexibility, in a cohort of autistic children (N = 247).
Family-stressful life events, assessed using the parent-reported Family
Inventory of Life Events and Changes, and mental health problems, assessed using
the teacher-reported Child Behavior Checklist Internalizing and Externalizing
Symptoms subscales, were measured at multiple points between 7 and 11 years.
Analyses showed no significant pathways from internalizing or externalizing
symptoms to family-stressful life events or from family-stressful life events to
internalizing or externalizing symptoms. There was some evidence of moderation
by cognitive flexibility; the family-stressful life events to internalizing
symptoms pathway was non-significant in the group with typical shifting ability
but significant in the group with clinically significant shifting problems.
Information about family-level stressful life event exposure and cognitive
flexibility may be helpful in identifying autistic youth who may be at higher
risk of developing mental health problems. Established risk factors for mental
health problems in neurotypical populations are relevant for understanding
mental health in autistic youth.
Collapse
Affiliation(s)
| | | | | | | | - Anat Zaidman-Zait
- Tel Aviv University, Israel
- The University of British Columbia, Canada
| | | | | | | | - Eric Duku
- Offord Centre for Child Studies, Canada
- McMaster University, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Canada
- McMaster University, Canada
| | | | - Isabel Smith
- Dalhousie University, Canada
- IWK Health Centre, Canada
| | | | - Peter Szatmari
- University of Toronto, Canada
- The Hospital for Sick Children, Canada
| | | |
Collapse
|
30
|
Taylor JL, Adams RE, Pezzimenti F, Zheng S, Bishop SL. Job loss predicts worsening depressive symptoms for young adults with autism: A COVID-19 natural experiment. Autism Res 2022; 15:93-102. [PMID: 34626164 PMCID: PMC8646555 DOI: 10.1002/aur.2621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/13/2021] [Accepted: 09/26/2021] [Indexed: 01/11/2023]
Abstract
Adults with autism spectrum disorder (ASD) experience high rates of both unemployment and depression. Though job loss predicts increased risk of depression in the general population, studies have yet to directly examine this relationship among individuals with ASD. With the backdrop of rising unemployment due to COVID-19, we used a longitudinal design to examine whether employment changes predicted increasing depressive symptoms among young adults with ASD. Online surveys were collected from young adults with ASD at two times: just before widespread social distancing measures were adopted in the United States, and again 10 weeks later. Both time points included measurement of depressive symptoms (Beck Depression Inventory-2). At Time 2, COVID-related employment changes and the perceived impact of those changes on well-being were collected. Of the young adults who were employed at Time 1 (n = 144), over one-third (37.5%) reported employment changes during the first 2 months of COVID-19. Most of this change was job loss or reductions in hours or pay ("job loss/reduction"). Controlling for Time 1 depressive symptoms, young adults who experienced job loss/reduction had significantly higher depressive symptoms at Time 2 than those without an employment change. Individuals' perceived impact of employment change also predicted depressive symptoms. These findings suggest that losing a job or experiencing reductions in hours or pay leads to worsening depressive symptoms among adults with ASD. Better supporting autistic adults in the workplace may not only decrease the likelihood of job loss, but also combat the exceedingly high rates of depression in this group. LAY SUMMARY: Though unemployment has been linked to mental health problems in the general population, this relationship is seldom considered among adults with autism. In this study, we found that adults on the autism spectrum who lost their jobs or experienced reductions in pay or hours during the first 2 months of COVID-19 had worsening depression compared to adults who did not have job changes. Our findings suggest that increasing access to employment may help alleviate poor mental health among autistic adults.
Collapse
Affiliation(s)
- Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan E Adams
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Florencia Pezzimenti
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
31
|
Zdankiewicz-Ścigała E, Ścigała D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation. PLoS One 2021; 16:e0255460. [PMID: 34428238 PMCID: PMC8384168 DOI: 10.1371/journal.pone.0255460] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The purpose of the study is to analyses the relationship between interoceptive sensibility and somatoform disorders among persons with Autism Spectrum Disorder (ASD). It has been assumed that the interoceptive sensibility is accompanied by a high level of alexithymia and emotion dysregulation in somatoform disorders. METHODS Persons under the care of the foundation helping people with ASD were asked to participate in the study. In total, 205 people took part in the research. The participants aged from 18 to 63 (M = 34.91; SD = 8.44). The ASD group comprised 79 persons (38.5% of subjects). The control group comprised 126 individuals (61.5% of subjects). Participants completed self-report questionnaires measuring autism (AQ), interoceptive sensibility (BPQ), alexithymia (TAS20), emotional dysregulation (DERS), and somatoform disorder (SDQ). RESULTS The analyses showed a moderation effect of the group, which indicates the existence of a relationship between interoceptive sensibility and somatoform disorders to the greater extent in the clinical group than in the control group. In addition, the serial multiple mediation model analysis allowed to verify the mediating effect of emotion dysregulation and alexithymia on the abovementioned relationship. The indirect effect, which assumed the mediating role of alexithymia turned out to be significant, contrary to the indirect effect where emotion dysregulation was a mediator in a situation where both variables were applied simultaneously. CONCLUSIONS Interoceptive sensibility correlated with level of alexithymia, in particular, difficulties in identifying and verbalizing emotions and emotion dysregulation in the lack of emotional awareness and lack of emotional clarity and is associated with somatoform disorders in the investigated group regardless of participants' belonging to the ASD or control group.
Collapse
Affiliation(s)
| | - Dawid Ścigała
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Joanna Sikora
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Wanda Kwaterniak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | |
Collapse
|
32
|
Hollocks MJ, Meiser-Stedman R, Kent R, Lukito S, Briskman J, Stringer D, Lord C, Pickles A, Baird G, Charman T, Simonoff E. The association of adverse life events and parental mental health with emotional and behavioral outcomes in young adults with autism spectrum disorder. Autism Res 2021; 14:1724-1735. [PMID: 34076371 DOI: 10.1002/aur.2548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
Abstract
People with autism spectrum disorder (ASD) are at increased risk of developing co-occurring mental health difficulties across the lifespan. Exposure to adverse life events and parental mental health difficulties are known risk factors for developing a range of mental health difficulties. This study investigates the association of adverse life events, parental stress and mental health with emotional and behavioral problems in young adults with ASD. One hundred and fifteen young adults with ASD derived from a population-based longitudinal study were assessed at three time-points (12-, 16-, and 23-year) on questionnaire measures of emotional and behavioral problems. Parent-reported exposure to adverse life events and parental stress/mental health were measured at age 23. We used structural equation modeling to investigate the stability of emotional and behavioral problems over time, and the association between adverse life events and parental stress and mental health and emotional and behavioral outcomes at 23-year. Our results indicate that exposure to adverse life events was significantly associated with increased emotional and behavioral problems in young adults with ASD, while controlling for symptoms in childhood and adolescence. Higher reported parental stress and mental health difficulties were associated with a higher frequency of behavioral, but not emotional problems, and did not mediate the impact of adverse life events. These results suggest that child and adolescent emotional and behavioral problems, exposure to life events and parent stress and mental health are independently associated, to differing degrees, with emotional or behavioral outcomes in early adulthood. LAY SUMMARY: People with autism experience high rates of mental health difficulties throughout childhood and into adult life. Adverse life events and parental stress and mental health may contribute to poor mental health in adulthood. We used data at three time points (12-, 16-, and 23-year) to understand how these factors relate to symptoms at 23-year. We found that emotional and behavioral problems in childhood, adverse life events and parent mental health were all associated with increased emotional and behavioral problems in adulthood.
Collapse
Affiliation(s)
- Matthew J Hollocks
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Rachel Kent
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
| | | | - Dominic Stringer
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience and Biomedical Research Centre for Mental Health, London, UK
| | - Catherine Lord
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience and Biomedical Research Centre for Mental Health, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Tony Charman
- Department of Psychology, King's College London, Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
33
|
Abstract
Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.
Collapse
Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| |
Collapse
|
34
|
Rumball F, Brook L, Happé F, Karl A. Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103848. [PMID: 33454451 DOI: 10.1016/j.ridd.2020.103848] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors. AIMS This study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group. METHODS Questionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults. RESULTS Rates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group. CONCLUSIONS High rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.
Collapse
Affiliation(s)
- Freya Rumball
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK; King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Lucinda Brook
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Francesca Happé
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Anke Karl
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
| |
Collapse
|
35
|
Shin SH, Wright C, Johnston S. Early Life Experiences Moderate the Relationship Between Genetic Risk of Autism and Current and Lifetime Mental Health. Front Psychiatry 2021; 12:772841. [PMID: 34916975 PMCID: PMC8669098 DOI: 10.3389/fpsyt.2021.772841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Although individuals with autism are at greater risk of mental health challenges than others, we know little about the relationship between the mental health of older adults (50+) and autism because they are less likely to be diagnosed. Identifying the risk and protective factors that are associated with mental health can increase educational awareness, inform clinical practice, and provide information to help diagnose and treat older adults with autism. This study used longitudinal panel data of the 2008-2016 waves of the Health and Retirement Study. It estimated individual random-effect models by interacting a genetic propensity toward autism and early life experiences to test whether the latter has a moderating effect on the relationships between genetics and the Center for Epidemiologic Studies Depression (CES-D) score, self-reported depression, and history of psychiatric problems. Results suggest that individuals with a higher genetic propensity for autism are less likely to develop psychiatric problems if they report a positive maternal relationship early in life. Further, a combined effect of police encounters early in life and genetic risk for autism is associated with higher CES-D scores, increased odds of self-reported depression, and a history of psychiatric problems. Clinical applications of these findings include the need to establish and support high-quality relationships by addressing both child and caregiver needs. Further, these findings support the need to design and implement proactive interventions to teach police and autistic individuals how to successfully navigate these encounters.
Collapse
Affiliation(s)
- Su Hyun Shin
- Department of Family & Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Cheryl Wright
- Department of Family & Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Susan Johnston
- Department of Special Education, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
36
|
Shulman C, Rice CE, Morrier MJ, Esler A. The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Psychiatr Clin North Am 2020; 43:605-628. [PMID: 33126998 DOI: 10.1016/j.psc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.
Collapse
Affiliation(s)
- Cory Shulman
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel.
| | - Catherine E Rice
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Michael J Morrier
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Amy Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota 2540 Riverside Ave S., RPB 550, Minneapolis, MN 55454, USA
| |
Collapse
|
37
|
Andreu Pascual M, Levenson JC, Merranko J, Gill MK, Hower H, Yen S, Strober M, Goldstein TR, Goldstein BI, Ryan ND, Weinstock LM, Keller MB, Axelson D, Birmaher B. The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder. J Affect Disord 2020; 274:126-135. [PMID: 32469795 PMCID: PMC7365761 DOI: 10.1016/j.jad.2020.05.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/02/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning. METHODS BD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening. RESULTS Accounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p<0.02). More TEs were associated with poorer mood course, particularly among victims of violence/abuse (p<0.02). Abused participants (34% physical; 17% sexual) showed earlier onset of substance use disorders, more suicidality and comorbidities compared to those without abuse. Comparisons of mood course before and after abuse occurred, and with participants without abuse, showed worsening mood symptoms after, specifically hypo/mania (p<0.03). LIMITATIONS Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; given approximate dates causality cannot be inferred; TEs severity was not assessed. CONCLUSIONS Severe TEs, particularly abuse, were associated with poorer course and outcomes among BD youth. Prompt screening of trauma and early intervention may be warranted to minimize TEs impact.
Collapse
Affiliation(s)
- Maria Andreu Pascual
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA.
| | - Jessica C Levenson
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA; Department of Psychiatry, School of Medicine, University of California at San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA, 90095, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON, M4N-3M5, Canada
| | - Neal D Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI, 02906, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI, 02906, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH, 43210, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| |
Collapse
|
38
|
Schwartzman JM, Corbett BA. Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 77:101613. [PMID: 32802155 PMCID: PMC7423017 DOI: 10.1016/j.rasd.2020.101613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Depression is more prevalent among male early adolescents with Autism Spectrum Disorder (ASD) than their typically- developing (TD) peers, but findings are limited to two male-only studies. Therefore, a broader understanding of depressive symptoms among both male and female early adolescents with ASD in larger samples is needed. Self- and parent-ratings are frequently used, yet rater differences may emerge and provide unique insights. METHOD Ratings of adolescent depressive symptoms were examined among 230 early adolescents (10:0-13:5 years) with and without ASD using self- (Children's Depression Inventory, Second Edition; CDI-2) and parent- report (Child Behavior Checklist; CBCL) measures. The influence of diagnostic group (ASD vs. TD) and rater (early adolescent vs. parent) on ratings were examined with Full Scale IQ and sex as covariates. Additionally, the reliability and strength of agreement between raters were examined. RESULTS Higher depressive symptoms were reported by both raters in the ASD group (Borderline range) compared to the TD group (Average range). The interaction of diagnostic group and rater was nonsignificant, but significant main effects emerged. Sex was a significant covariate, but Full Scale IQ was not. The reliability and strength of agreement between raters in the ASD group only were not significant. CONCLUSIONS Findings suggest that depressive symptoms may be higher in both male and female early adolescents with ASD across self- and parent- reports. However, measurement of depression in ASD may be complicated by nonsignificant reliability and strength of agreement between raters. Results have implications for screening and intervention for early adolescents with ASD.
Collapse
Affiliation(s)
- Jessica M. Schwartzman
- Vanderbilt University Medical Center, 1601 23 Avenue South, Nashville, TN, United States 37212
| | - Blythe A. Corbett
- Vanderbilt University Medical Center, 1601 23 Avenue South, Nashville, TN, United States 37212
- Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN, United States 37203
| |
Collapse
|
39
|
Hoch JD, Youssef AM. Predictors of Trauma Exposure and Trauma Diagnoses for Children with Autism and Developmental Disorders Served in a Community Mental Health Clinic. J Autism Dev Disord 2020; 50:634-649. [PMID: 31838644 PMCID: PMC6994449 DOI: 10.1007/s10803-019-04331-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Exposure to potentially traumatic events (PTEs), and trauma related diagnoses are poorly understood in autism spectrum disorders (ASD) and developmental disabilities (DD). The current study examined N = 7695 cases seen by a community mental health provider to compare exposure to PTEs and trauma-related diagnoses between children with ASD, children with DD, and children with other mental health diagnoses (e.g., depression). Predictors included demographics, exposure to negative life events, living situations, and subscales of the strengths and difficulties questionnaire (SDQ). Logistic regressions showed that diagnostic group, number and type of negative life events and locations lived, and SDQ subscale scores predicted trauma reports and trauma diagnoses. The findings suggest screener questions that may be useful across diagnostic groups.
Collapse
Affiliation(s)
- John D Hoch
- Fraser, 3333 University Ave SE, Minneapolis, MN, 55414, USA.
| | - Adriana M Youssef
- Institute for Translational Research in Children's Mental Health, University of Minnesota, 1100 Washington Avenue South, Minneapolis, MN, USA
| |
Collapse
|
40
|
Murphy D. Autism: Implications for high secure psychiatric care and move towards best practice. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103615. [PMID: 32113075 DOI: 10.1016/j.ridd.2020.103615] [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: 07/08/2019] [Revised: 01/30/2020] [Accepted: 02/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND/AIMS To explore the role of high secure psychiatric care (HSPC) in the assessment and management of individuals with an Autism Spectrum Disorder (ASD) using published studies and clinical experience. Key areas of exploration include the prevalence of ASD within HSPC, some autism specific issues including clinical and cognitive characteristics, psychopathy and emotional regulation, presence of incompatibilities and use of seclusion, as well as experiences of being detained in HSPC. Developing best practice and a specialist ASD service in HSPC is also discussed. METHOD A discussion of available literature, supported by clinical experience. CONCLUSIONS Although individuals with an ASD admitted to HSPC comprise a small group, they are likely to be overrepresented relative to the general prevalence of ASD in the population and present with specific issues. Whilst individuals report a generally positive experience of HSPC, therapeutic outcomes are variable and the factors influencing them poorly understood. Staff knowledge and application of ASD theory and practice appears to have a significant influence on outcomes. IMPLICATIONS Although best practice concerning ASD secure services will continue to be improved and developed, the role of HSPC in the assessment and management of some individuals with an ASD who present with complex needs and high risk behaviours remains clear.
Collapse
Affiliation(s)
- David Murphy
- Broadmoor High Secure Psychiatric Hospital, Crowthorne, RG457EG, Berkshire, United Kingdom.
| |
Collapse
|
41
|
Gaigg SB, Flaxman PE, McLaven G, Shah R, Bowler DM, Meyer B, Roestorf A, Haenschel C, Rodgers J, South M. Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:867-883. [PMID: 32267168 PMCID: PMC7418273 DOI: 10.1177/1362361320909184] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.
Collapse
Affiliation(s)
| | | | - Gracie McLaven
- City, University of London, London, UK
- King’s College London, UK
| | - Ritika Shah
- City, University of London, London, UK
- MAPS Psychology, India
| | | | | | | | | | | | | |
Collapse
|
42
|
Rumball F, Happé F, Grey N. Experience of Trauma andPTSDSymptoms in Autistic Adults: Risk ofPTSDDevelopment FollowingDSM‐5 andNon‐DSM‐5 Traumatic Life Events. Autism Res 2020; 13:2122-2132. [DOI: 10.1002/aur.2306] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Freya Rumball
- King's College London London UK
- South London and Maudsley NHS Foundation Trust London UK
| | | | - Nick Grey
- Sussex Partnership NHS Foundation Trust Worthing UK
- University of Sussex Brighton UK
| |
Collapse
|
43
|
Haruvi-Lamdan N, Horesh D, Zohar S, Kraus M, Golan O. Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:884-898. [PMID: 32245333 DOI: 10.1177/1362361320912143] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
LAY ABSTRACT People with Autism Spectrum Disorder show an increased risk of experiencing traumatic events, particularly social victimization. However, Autism Spectrum Disorder and Post-Traumatic Stress Disorder co-occurrence was hardly studied. We examined exposure to traumatic life events and Post-Traumatic Stress Disorder symptoms in adults with Autism Spectrum Disorder vs typical adults. Two groups took part in this study: Twenty-five adults with Autism Spectrum Disorder and 25 typical adults of similar age and male to female ratio. Participants completed questionnaires on potentially traumatic life events of social and non-social nature, as well as on Post-Traumatic Stress Disorder symptoms related to their most distressing event. Participants also filled out an autism traits questionnaire. Results showed a higher Post-Traumatic Stress Disorder rate in the Autism Spectrum Disorder group (32%) compared with the typical group (4%). Individuals with Autism Spectrum Disorder reported more Post-Traumatic Stress Disorder symptoms, particularly re-experiencing and increased physiological arousal, compared with typical adults, although the latter was elevated only in females with Autism Spectrum Disorder. Participants with Autism Spectrum Disorder, especially females, reported more negative life events, particularly social events, than typical adults. Sixty percent of Autism Spectrum Disorder participants, but only 20% of typical participants, chose a social event as their most distressing event. Individuals with Autism Spectrum Disorder who were also suspected as having Post-Traumatic Stress Disorder (based on their questionnaires) presented poorer social skills compared with those with Autism Spectrum Disorder alone. Results indicate that individuals with Autism Spectrum Disorder are more susceptible to trauma and Post-Traumatic Stress Disorder, particularly due to social stressors. Females with Autism Spectrum Disorder may be especially vulnerable to Post-Traumatic Stress Disorder.
Collapse
Affiliation(s)
| | - Danny Horesh
- Bar-Ilan University, Israel.,New York University, USA.,Autism Treatment & Research Center, Association for Children at Risk, Israel
| | | | | | - Ofer Golan
- Bar-Ilan University, Israel.,Autism Treatment & Research Center, Association for Children at Risk, Israel.,University of Cambridge, UK
| |
Collapse
|
44
|
The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Child Adolesc Psychiatr Clin N Am 2020; 29:275-299. [PMID: 32169263 DOI: 10.1016/j.chc.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.
Collapse
|
45
|
Understanding Suicide Risk in Autistic Adults: Comparing the Interpersonal Theory of Suicide in Autistic and Non-autistic Samples. J Autism Dev Disord 2020; 50:3620-3637. [DOI: 10.1007/s10803-020-04393-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
46
|
Lind T, Lau AS, Gomez C, Rodriguez A, Guan K, Chlebowski C, Zhang A, Chorpita B, Brookman-Frazee L. Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1286-1299. [PMID: 32003224 DOI: 10.1177/1362361319881084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Mental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was An Individualized Mental Health Intervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.
Collapse
Affiliation(s)
- Teresa Lind
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher Gomez
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Adriana Rodriguez
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Karen Guan
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Aimee Zhang
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Bruce Chorpita
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Child and Adolescent Services Research Center, San Diego, CA, USA.,Autism Discovery Institute, Rady Children's Hospital, San Diego, CA, USA
| |
Collapse
|
47
|
Alnujaim I, Kim Y. Augmentation of Doppler Radar Data Using Generative Adversarial Network for Human Motion Analysis. Healthc Inform Res 2019; 25:344-349. [PMID: 31777679 PMCID: PMC6859266 DOI: 10.4258/hir.2019.25.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Human motion analysis can be applied to the diagnosis of musculoskeletal diseases, rehabilitation therapies, fall detection, and estimation of energy expenditure. To analyze human motion with micro-Doppler signatures measured by radar, a deep learning algorithm is one of the most effective approaches. Because deep learning requires a large data set, the high cost involved in measuring large amounts of human data is an intrinsic problem. The objective of this study is to augment human motion micro-Doppler data employing generative adversarial networks (GANs) to improve the accuracy of human motion classification. Methods To test data augmentation provided by GANs, authentic data for 7 human activities were collected using micro-Doppler radar. Each motion yielded 144 data samples. Software including GPU driver, CUDA library, cuDNN library, and Anaconda were installed to train the GANs. Keras-GPU, SciPy, Pillow, OpenCV, Matplotlib, and Git were used to create an Anaconda environment. The data produced by GANs were saved every 300 epochs, and the training was stopped at 3,000 epochs. The images generated from each epoch were evaluated, and the best images were selected. Results Each data set of the micro-Doppler signatures, consisting of 144 data samples, was augmented to produce 1,472 synthesized spectrograms of 64 × 64. Using the augmented spectrograms, the deep neural network was trained, increasing the accuracy of human motion classification. Conclusions Data augmentation to increase the amount of training data was successfully conducted through the use of GANs. Thus, augmented micro-Doppler data can contribute to improving the accuracy of human motion recognition.
Collapse
Affiliation(s)
- Ibrahim Alnujaim
- Department of Electrical and Computer Engineering, California State University, Fresno, CA, USA
| | - Youngwook Kim
- Department of Electrical and Computer Engineering, California State University, Fresno, CA, USA
| |
Collapse
|
48
|
Mucci F, Toni C, Favaretto E, Vannucchi G, Marazziti D, Perugi G. Obsessive-compulsive Disorder with Comorbid Bipolar Disorders: Clinical Features and Treatment Implications. Curr Med Chem 2019; 25:5722-5730. [PMID: 29119914 DOI: 10.2174/0929867324666171108145127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) symptoms within the context of a bipolar disorder (BD) have been described since the 19th century. Interestingly, the existence of a relevant overlap between the aforementioned psychiatric syndromes has been confirmed by a number of recent epidemiological and family studies. AIMS The aim of the present paper is to review the clinical features and the therapeutic implications of the OCD-BD comorbidity. DISCUSSION In the last two decades, the frequent association between OCD and BD has been earning a growing interest given its relevant nosological and therapeutic implications. Usually patients suffering from OCD-BD comorbidity show a peculiar clinical course, characterized by a larger number of concomitant depressive episodes and episodic course. In these cases, the treatment with antidepressants is more likely to elicit hypomanic or manic switches, while mood stabilizers significantly improve the overall clinical picture. Moreover, OCD-BD patients are frequently comorbid with a number of other psychiatric disorders, in particular anxiety disorders, social phobia, and different substance abuses, such as alcohol, nicotine, caffeine and sedatives. CONCLUSIONS BD-OCD comorbidity needs further investigations in order to provide more solid evidences to give patients a more precise clinical diagnosis and a more targeted therapeutic approach.
Collapse
Affiliation(s)
- Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Cristina Toni
- Istituto di scienze comportamentali G. De Lisio, Carrara, Italy
| | - Ettore Favaretto
- Centro di salute mentale, Ospedale di Bressanone, Bressanone, Italy
| | - Giulia Vannucchi
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Giulio Perugi
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
49
|
Griffiths S, Allison C, Kenny R, Holt R, Smith P, Baron-Cohen S. The Vulnerability Experiences Quotient (VEQ): A Study of Vulnerability, Mental Health and Life Satisfaction in Autistic Adults. Autism Res 2019; 12:1516-1528. [PMID: 31274233 PMCID: PMC6851759 DOI: 10.1002/aur.2162] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/03/2019] [Accepted: 05/27/2019] [Indexed: 01/07/2023]
Abstract
Co‐morbid mental health conditions such as anxiety and depression are extremely common in autistic adults. Vulnerability to negative life experiences such as victimisation and unemployment may be partially responsible for the development of these conditions. Here we measure the frequency of negative life experiences in autistic adults and explore how these are associated with current anxiety and depression symptoms and life satisfaction. We developed the Vulnerability Experiences Quotient (VEQ) through stakeholder consultation. The VEQ includes 60 items across 10 domains. Autistic adults with a clinical diagnosis and non‐autistic controls completed the VEQ, screening measures for anxiety and depression, and a life‐satisfaction scale in an online survey. Likelihood of experiencing each VEQ event was compared between groups, using binary logistic regression. Mediation analysis was used to test whether total VEQ score mediated the relationship between autism and (1) depression (2) anxiety and (3) life satisfaction. Autistic adults (N = 426) reported higher rates of the majority of events in the VEQ than non‐autistic adults (N = 268). They also reported more anxiety and depression symptoms and lower life satisfaction. Group differences in anxiety, depression and life satisfaction were partially mediated by VEQ total score. This study highlights several important understudied areas of vulnerability for autistic adults, including domestic abuse, contact with social services (as parents) and financial exploitation and hardship. Improved support, advice and advocacy services are needed to reduce the vulnerability of autistic adults to negative life experiences, which may in turn improve mental health and life satisfaction in this population. Autism Res 2019, 12: 1516–1528. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary This study investigated whether autistic adults are more vulnerable to certain negative life experiences, and whether these experiences are related to anxiety, depression and life satisfaction. We found that autistic adults are more vulnerable to many different negative life events, including employment difficulties, financial hardship and domestic abuse. Negative life experiences partially explained the higher rates of anxiety and depression symptoms and lower life satisfaction in autistic adults compared to non‐autistic adults. Improved support services are required to reduce the vulnerability of autistic adults. Reducing vulnerability may improve mental health and increase life satisfaction in this population.
Collapse
Affiliation(s)
- Sarah Griffiths
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca Kenny
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Rosemary Holt
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,CLASS Clinic, Cambridgeshire and Peterborough Mental Health NHS Foundation Trust (CPFT), Cambridge, United Kingdom
| |
Collapse
|
50
|
Abstract
Depression is both common and impactful in youth with autism spectrum disorder (ASD) and is swiftly growing in recognition as a major public health concern within the autism community. This article is intended to provide a brief overview of the prevalence, impact, presentation, and risk factors associated with cooccurring depression in children and adolescents with ASD. Clinical guidelines for the assessment and treatment of depression in the ASD population are offered in line with the small existing evidence base.
Collapse
|