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Gaudreau C, Guillaumie L, Jobin É, Diallo TA. Nurses and Climate Change: A Narrative Review of Nursing Associations' Recommendations for Integrating Climate Change Mitigation Strategies. Can J Nurs Res 2024; 56:193-203. [PMID: 38373438 PMCID: PMC11308299 DOI: 10.1177/08445621241229932] [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: 02/21/2024] Open
Abstract
BACKGROUND According to the World Health Organization, climate change is the greatest challenge of the twenty-first century. It is already affecting the health of many Canadians through extreme heat, wildfires and the expansion of zoonotic diseases. As trusted professionals, nurses are in favourable position to take action on climate change. PURPOSE To document the recommendations issued by Quebec, Canadian, American and international nursing associations regarding nursing practices that address climate change or environmental issues. METHODS This narrative review was conducted by establishing a list of environmental and general nursing associations in the geographical areas of interest through Google searches as well as by retrieving documents about climate change or environmental issues published by these organizations on their websites. Data related to the documents' characteristics and recommended nursing roles were then extracted. RESULTS The review identified 13 nurses' organizations and 20 documents describing 37 recommendations for nurses in seven socioecological areas: individual, patient-focused, workplace, nursing associations, public health organizations, political and education. CONCLUSIONS There is a gap between the breadth of roles that nurses may be called upon to play in addressing climate change and the degree to which relevant organizations are prepared to create the required conditions for them to do so. Several lessons emerged, including that the urgency of the climate crisis requires clear guidelines on how nurses can integrate climate change and its resultant health concerns into practice through nurses' associations, education and bottom-up nursing innovations. Funding is required for such initiatives, which must also prioritize health inequalities.
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Affiliation(s)
- Coralie Gaudreau
- Faculty of Nursing Sciences, Public/Community Health Programs, Université Laval, Quebec City, Quebec, Canada
| | - Laurence Guillaumie
- Faculty of Nursing Sciences, Public/Community Health Programs, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec–Université Laval Research Centre, Québec, Québec, Canada
| | - Édith Jobin
- Faculty of Nursing Sciences, Public/Community Health Programs, Université Laval, Quebec City, Quebec, Canada
| | - Thierno Amadou Diallo
- Faculty of Nursing Sciences, Public/Community Health Programs, Université Laval, Quebec City, Quebec, Canada
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Klein CB, Klinger LG. Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare (Basel) 2024; 12:1207. [PMID: 38921321 PMCID: PMC11203987 DOI: 10.3390/healthcare12121207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
With autism first recognized in the 1940s, the early cohorts of autistic children are beginning to enter older adulthood. Little is known about the experiences and outcomes of autistic older adults. In the general population, "successful aging" is a dominant model among gerontologists and is used to evaluate outcomes in older adulthood. This narrative review aims to provide a framework for understanding and supporting successful aging in older autistic adults. Using Fernández-Ballesteros' four-domain model of "aging well" we review knowledge on aging and autism by examining outcomes in health and functioning, cognitive and physical functioning, positive affect and control, and social participation and engagement. Findings indicate that outcomes in autistic older adults are generally poor, marked by increased medical conditions, low adaptive skills, elevated risk of cognitive decline, limited physical activity, high rates of mental health conditions, low quality of life, and reduced social or community participation. Patterns of challenges are similar across cognitive abilities and profiles of autistic traits. Challenges and next steps in aging and autism research are identified, and future directions for the field are discussed.
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Affiliation(s)
- Claire B. Klein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura G. Klinger
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Wilson AC. Cognitive Profile in Autism and ADHD: A Meta-Analysis of Performance on the WAIS-IV and WISC-V. Arch Clin Neuropsychol 2024; 39:498-515. [PMID: 37779387 PMCID: PMC11110614 DOI: 10.1093/arclin/acad073] [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] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Previous research has suggested that neurodevelopmental conditions may be associated with distinctive cognitive profiles on the Wechsler intelligence tests (of which the most recent editions are the WAIS-IV and WISC-V). However, the extent to which a cognitive profile can be reliably identified for individuals meeting criteria for autism or ADHD remains unclear. The present review investigated this issue. METHOD A search was conducted in PsycInfo, Embase, and Medline in October 2022 for papers reporting the performance of children or adults diagnosed with autism or ADHD on the WAIS-IV or the WISC-V. Test scores were aggregated using meta-analysis. RESULTS Scores were analyzed from over 1,800 neurodivergent people reported across 18 data sources. Autistic children and adults performed in the typical range for verbal and nonverbal reasoning, but scored ~1 SD below the mean for processing speed and had slightly reduced scores on working memory. This provides evidence for a "spiky" cognitive profile in autism. Performance of children and adults with ADHD was mostly at age-expected levels, with slightly reduced scores for working memory. CONCLUSION Although the pattern of performance on the Wechsler tests is not sufficiently sensitive or specific to use for diagnostic purposes, autism appears to be associated with a cognitive profile of relative strengths in verbal and nonverbal reasoning and a weakness in processing speed. Attention deficit hyperactivity disorder appears less associated with a particular cognitive profile. Autistic individuals may especially benefit from a cognitive assessment to identify and support with their strengths and difficulties.
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Leung FYN, Stojanovik V, Jiang C, Liu F. Investigating implicit emotion processing in autism spectrum disorder across age groups: A cross-modal emotional priming study. Autism Res 2024; 17:824-837. [PMID: 38488319 DOI: 10.1002/aur.3124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/01/2024] [Indexed: 04/13/2024]
Abstract
Cumulating evidence suggests that atypical emotion processing in autism may generalize across different stimulus domains. However, this evidence comes from studies examining explicit emotion recognition. It remains unclear whether domain-general atypicality also applies to implicit emotion processing in autism and its implication for real-world social communication. To investigate this, we employed a novel cross-modal emotional priming task to assess implicit emotion processing of spoken/sung words (primes) through their influence on subsequent emotional judgment of faces/face-like objects (targets). We assessed whether implicit emotional priming differed between 38 autistic and 38 neurotypical individuals across age groups as a function of prime and target type. Results indicated no overall group differences across age groups, prime types, and target types. However, differential, domain-specific developmental patterns emerged for the autism and neurotypical groups. For neurotypical individuals, speech but not song primed the emotional judgment of faces across ages. This speech-orienting tendency was not observed across ages in the autism group, as priming of speech on faces was not seen in autistic adults. These results outline the importance of the delicate weighting between speech- versus song-orientation in implicit emotion processing throughout development, providing more nuanced insights into the emotion processing profile of autistic individuals.
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Affiliation(s)
- Florence Y N Leung
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Vesna Stojanovik
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cunmei Jiang
- Music College, Shanghai Normal University, Shanghai, China
| | - Fang Liu
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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5
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Patel K, Fogler J, Sideridis G, Soares N. Profiles of Autistic Youth with and Without Co-occurring Behavioral Health and Neurodevelopmental Disorders: A Latent Class Analysis. J Dev Behav Pediatr 2024; 45:e129-e136. [PMID: 38290110 DOI: 10.1097/dbp.0000000000001246] [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] [Received: 05/24/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) diagnosis relies on clinical observation and documentation, but the presence of comorbidities can affect diagnostic validity across clinicians and exacerbate access to timely care. This study used latent class analysis to optimize subgroup identification based on functional level and associated comorbidities using the Behavior Assessment System for Children, Third Edition (BASC-3), and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), in a pediatric population referred for autism evaluation. METHODS This retrospective study reviewed clinical data extracted over a 3-year period (2018-2021). A latent class analysis was used to explore the presence of latent groups guided by the likelihood ratio test and fit indices. Additional analyses contrasted ASD and non-ASD groups on the BASC-3 and Vineland-3 variables. RESULTS There were 191 included participants (mean age 65.9 months, 76.4% male), of whom over half (60.7%) had an ASD diagnosis. Using 185 cases, the exploratory latent class analysis showed the emergence of 4 distinct subgroups. Composition of classes varied on ASD diagnosis, neurodevelopmental difficulties, behavioral health concerns, and intellectual disability. When contrasting ASD and non-ASD groups, significant between-group differences were observed across Vineland-3 variables and BASC-3 adaptive skills subscales indicating poorer social and adaptive functioning. CONCLUSION Latent class analysis of commonly used behavioral and adaptive measures can help distinguish between subgroups of pediatric patients referred for ASD evaluations and assist in triage of cases based on severity.
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Affiliation(s)
- Khusbu Patel
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI; and
| | - Jason Fogler
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI; and
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Curran C, Roberts R, Gannoni A, Jeyaseelan D. Training and Educational Pathways for Clinicians (Post-graduation) for the Assessment and Diagnosis of Autism Spectrum Disorders: A Scoping Review. J Autism Dev Disord 2024:10.1007/s10803-023-06202-4. [PMID: 38177895 DOI: 10.1007/s10803-023-06202-4] [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: 11/22/2023] [Indexed: 01/06/2024]
Abstract
This review aimed to identify the post-graduation training pathways available for both clinicians and trainers in the assessment and diagnosis of Autism Spectrum Disorder (ASD). The study was guided by two research questions: What is known about ASD-specific educational, training, or other pathways available to support clinicians of any discipline, post-graduation, to meet the required expertise relevant to assessments of ASD concerns? What is known about the educational pathways available to clinicians seeking to provide training to other clinicians, post-graduation, in the assessment of ASD concerns? A scoping review was undertaken with searches completed across five databases (PubMed, PsycINFO, PsycEXTRA, ERIC and CINAHL). A Google search strategy was also executed using the "advanced" search function. Eligible records were literature, written in English, that examined post-graduation training and/ or education of clinicians to assess and/ or diagnose ASD. Fourteen relevant records were identified. Post-graduate training has the potential to enhance clinician confidence and service provision in ASD assessment and diagnosis. System-wide training approaches show promise in building large-scale, diagnostic capacity and the use of tele-mentoring offers a cost-effective, convenient mode of training delivery. A lack of evidence to support ASD diagnostic training pathways was found and may pose a challenge for clinicians and service users. The limited evidence found suggests that high quality research will be fundamental in determining how to build clinician capacity in ASD assessment and diagnosis and to ascertain whether training pathways are a necessary component.
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Affiliation(s)
- Christine Curran
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Rachel Roberts
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.
| | - Anne Gannoni
- Child and Adolescent Mental Health Service, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Deepa Jeyaseelan
- Child Development Unit, Women's and Children's Health Network, North Adelaide, SA, Australia
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Zavaleta-Ramírez P, Rosetti M, Albores-Gallo L, López ON, González PP. Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions. Clin Child Psychol Psychiatry 2024; 29:232-244. [PMID: 37541309 DOI: 10.1177/13591045231193817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente Muñiz, México City, México
| | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Omar Nafate López
- Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, México
| | - Paula Padierna González
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
- Fundación Alicia Koplowitz, Madrid, España
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8
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French B, Daley D, Groom M, Cassidy S. Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. J Atten Disord 2023; 27:1393-1410. [PMID: 37341291 PMCID: PMC10498662 DOI: 10.1177/10870547231176862] [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] [Indexed: 06/22/2023]
Abstract
BACKGROUND The two most prevalent neurodevelopmental disorders-Attention Deficit Hyperactivity Disorder (ADHD) and Autism (ASD)-(ASD/ADHD) strongly impact individuals' functions. This is worsened when individuals are undiagnosed and risks such as increased imprisonments, depression or drug misuse are often observed. This systematic review synthesizes the risks associated with late/undiagnosed ASD/ADHD. METHODS Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included, lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in English. The findings were summarize through a narrative synthesis. RESULTS Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks highlighted a significant impact on mental wellbeing and social interactions, higher risks of substance abuse, accidents and offending behavior as well as lower levels of income and education. DISCUSSION The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative outcomes affecting individuals, their families, and the wider society. The restricted number of studies on ASD are a limitation to the generalization of these findings Implications for research and practice are discussed, highlighting the importance of screening and acknowledging the possibility of ASD/ADHD in many settings such as psychiatric and forensic.
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“I Always Knew I Was Different”: Experiences of Receiving a Diagnosis of Autistic Spectrum Disorder in Adulthood—a Meta-Ethnographic Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AbstractA broadening of diagnostic criteria and increased awareness of autism has led to a large number of individuals whose difficulties remained undetected until adulthood. This systematic review aimed to synthesise empirical evidence of the experience of individuals who received their diagnosis of autism in adulthood. Eight studies met the inclusion criteria. A meta-ethnographic approach was used to synthesise the findings. Analysis revealed two meta-themes: feeling “like an alien” and the “not guilty” verdict, each with three associated subthemes. The findings indicate the need for timely diagnosis and provision of post-diagnostic support to alleviate the mental health implications of not having a framework to understand one’s experiences and to support the process of adjustment to the diagnosis.
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10
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Misdiagnosis of Psychosis and Obsessive-Compulsive Disorder in a Young Patient with Autism Spectrum Disorder. Case Rep Psychiatry 2023; 2023:7705913. [PMID: 36824478 PMCID: PMC9943599 DOI: 10.1155/2023/7705913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and the presence of restricted and repetitive patterns of behavior. Making a first diagnosis of ASD in adults has certain difficulties, including inaccurate recall of developmental history and overlapping behaviors with other psychiatric conditions. This case study presents a young man who was assessed to have no major mental illness during his first visit to emergency services in a psychiatric hospital. During his second visit, he was initially assessed to have first episode psychosis, due to his possible delusional beliefs related to the insurance payout, social withdrawal, and strange behaviors, and then later he was assessed to have obsessive-compulsive disorder (OCD) instead of psychosis, because of his recurrent and intrusive thoughts. Eventually, his diagnosis was revised to ASD during outpatient follow-up after more comprehensive assessment. It is not easy to differentiate ASD from psychosis among some adult patients, even for expert psychiatrists. Cognitive rigidity in ASD may be similar to delusions in psychosis. Unusual behaviors in ASD can be confused with disorganized behaviors in psychosis. Differentiating ASD from OCD can be a complicated task as well, due to similarities between ASD and OCD. Restricted interests and repetitive behaviors in ASD may be perceived as obsessions and compulsions in OCD. Overall, diagnosis of ASD in adults requires comprehensive evaluation. Distinguishing symptoms of OCD and psychosis from autistic traits is critical for accurate diagnosis and optimal treatment. Although research in adult ASD has expanded alongside increased prevalence statistics over the past few years, more efforts to enhance the diagnostic processes in adult ASD are needed to reduce the challenges in this field.
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Wigham S, Ingham B, Le Couteur A, Wilson C, Ensum I, Parr JR. A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1959-1972. [PMID: 35168407 PMCID: PMC9597166 DOI: 10.1177/13623613211073020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT Living with undiagnosed autism can be distressing and may affect mental health. A diagnosis of autism can help self-awareness and self-understanding. However, it can be difficult for adults to access an autism assessment. Clinicians also sometimes find it hard to identify autism in adults. This may mean an autism diagnosis is delayed or missed. In this study, we asked autistic adults, relatives and clinicians how to improve this. The study was in two stages. In the first stage (stage 1), 343 autistic adults and 45 relatives completed a survey. In the survey, we asked questions about people's experiences of UK autism assessment services for adults. Thirty-five clinicians completed a similar survey. Clinicians reported that some autism assessment teams lacked key professionals, for example, psychologists and occupational therapists. We used the information from the three separate surveys to create 13 statements describing best autism assessment services for adults. In stage 2, we asked clinicians for their views on the 13 statements. Clinicians agreed with 11 of the statements. Some autistic adults, relatives and clinicians were positive about autism assessment services, and many also described areas that could be improved. The study findings can be used to improve UK adult autism assessment services and may be helpful for service developments worldwide.
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Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute,
Newcastle University, UK
| | - Barry Ingham
- Population Health Sciences Institute,
Newcastle University, UK
- Cumbria, Northumberland, Tyne and Wear
NHS Foundation Trust, UK
| | - Ann Le Couteur
- Population Health Sciences Institute,
Newcastle University, UK
| | - Colin Wilson
- Population Health Sciences Institute,
Newcastle University, UK
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon
and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Jeremy R Parr
- Population Health Sciences Institute,
Newcastle University, UK
- Cumbria, Northumberland, Tyne and Wear
NHS Foundation Trust, UK
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12
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Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum's capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.
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Affiliation(s)
- Elizabeth Pellicano
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Unsa Fatima
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Gabrielle Hall
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Melanie Heyworth
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
- Reframing Autism, Sydney, New South Wales Australia
| | - Wenn Lawson
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Rozanna Lilley
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Joanne Mahony
- Macquarie School of Education, Macquarie University, Sydney, New South Wales Australia
| | - Marc Stears
- UCL Policy Lab, University College London, London, UK
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Spain D, Stewart GR, Mason D, Milner V, Fairhurst B, Robinson J, Gillan N, Ensum I, Stark E, Happe F. Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals. JMIR Ment Health 2022; 9:e37901. [PMID: 35857358 PMCID: PMC9302612 DOI: 10.2196/37901] [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: 03/10/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. OBJECTIVE This study explored health professionals' experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. METHODS A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. RESULTS Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals' experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. CONCLUSIONS A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- The National Psychology Clinic, London, United Kingdom
| | - Gavin R Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Victoria Milner
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- The National Psychology Clinic, London, United Kingdom
| | - Bryony Fairhurst
- The National Psychology Clinic, London, United Kingdom
- Berrywood Hospital, Northampton Healthcare National Health Service Foundation Trust, Northampton, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | | | - Francesca Happe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Amer YS, Alenezi S, Bashiri FA, Alawami AH, Alhazmi AS, Aladamawi SA, Alnemary F, Alqahtani Y, Buraik MW, AlSuwailem SS, Akhalifah SM, Augusta de Souza Pinhel M, Penner M, Elmalky AM. AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1050. [PMID: 35884034 PMCID: PMC9323940 DOI: 10.3390/children9071050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder requiring multimodal intervention and an army of multidisciplinary teams for a proper rehabilitation plan. Accordingly, multiple practice guidelines have been published for different disciplines. However, systematic evidence to detect and intervene must be updated regularly. Our main objective is to compare and summarize the recommendations made in the clinical practice guidelines (CPGs) for ASD in children released from November 2015 to March 2022. METHODS CPGs were subjected to a systematic review. We developed the inclusion and exclusion criteria and health-related questions, then searched and screened for CPGs utilizing bibliographic and CPG databases. Each of the CPGs used in the study were critically evaluated using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument. In a realistic comparison table, we summarized the recommendations. RESULTS Four eligible CPGs were appraised: Australian Autism CRC (ACRC); Ministry of Health New Zealand (NZ); National Institute for Health and Care Excellence (NICE); and Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland (SIGN-HIS). The overall assessments of all four CPGs scored greater than 80%; these findings were consistent with the high scores in the six domains of AGREE II, including: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. Domain (3) scored 84%, 93%, 86%, and 85%; domain (5) 92%, 89%, 54%, and 85%; and domain (6) 92%, 96%, 88%, and 92% for ACRC, NICE, NZ, and SIGN-HIS, respectively. Overall, there were no serious conflicts between the clinical recommendations of the four CPGs, but some were more comprehensive and elaborative than others. CONCLUSIONS All four assessed evidence-based CPGs demonstrated high methodological quality and relevance for use in practice.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh 11451, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, Scotland, UK
| | - Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahad A. Bashiri
- Pediatric Neurology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Amel Hussain Alawami
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Ayman Shawqi Alhazmi
- Developmental Pediatric Department, Children’s Hospital, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia;
| | - Somayyah A. Aladamawi
- King Abdullah bin Abdulaziz University Hospital, Riyadh 11564, Saudi Arabia;
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Faisal Alnemary
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | | | - Maysaa W. Buraik
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Saleh S. AlSuwailem
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Shahad M. Akhalifah
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Marcela Augusta de Souza Pinhel
- Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil;
- Department of Molecular Biology, São José do Rio Preto Medical School, São José do Rio Preto 15090-000, Brazil
| | - Melanie Penner
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada;
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ahmed M. Elmalky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia;
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo 3863130, Egypt
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15
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Spain D, Stewart GR, Mason D, Robinson J, Capp SJ, Gillan N, Ensum I, Happé F. Autism Diagnostic Assessments With Children, Adolescents, and Adults Prior to and During the COVID-19 Pandemic: A Cross-Sectional Survey of Professionals. Front Psychiatry 2022; 13:789449. [PMID: 35573336 PMCID: PMC9096098 DOI: 10.3389/fpsyt.2022.789449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Access to timely high quality autism diagnostic assessments has traditionally been patchy; many individuals wait months, if not years, for an appointment. The onset of the COVID-19 pandemic has likely impacted autism diagnostic services. This study investigated professionals' experiences of, and thoughts about: (1) how autism diagnostic assessments were conducted before the pandemic; (2) adaptations to service provision because of the pandemic; and (3) challenges, risks, advantages and opportunities associated with autism assessments conducted via online platforms (telehealth). Method Fifty-two professionals, based in different autism diagnostic services and working with children, adolescents and/or adults, completed an online cross-sectional survey in August and September 2020. This comprised demographic questions (about professionals' roles and experiences), and closed and open questions about service provision and telehealth autism assessments. Results There was substantial variation in how autism assessments were conducted prior to and during the pandemic; for example, in relation to the number of professionals involved in the assessment and types of structured, semi-structured and unstructured measures used to conduct this. Fifty-two percent of participants (n = 27) reported some service disruption (e.g., full closure, substantial reduction in provision, and/or pausing of in person appointments). Waiting times for assessment had become longer for 58% of services (n = 30), due to pandemic-related disruption. Six themes emerged from thematic analysis of open responses: (1) the autism diagnostic pathway, pre-pandemic; (2) initial impact of the pandemic on service delivery; (3) conducting autism assessments during the pandemic; (4) working remotely; (5) improving service design and delivery; and (6) post-diagnostic support. Views about the accessibility, validity, and reliability of conducting telehealth autism assessments were polarized. Some participants considered this efficient, flexible, and adequate; others viewed this as unethical and inappropriate. What constitutes good practice in telehealth autism assessments remains unclear, but there is a general openness to using this method (potentially in a hybrid telehealth-in person model), provided rigor and standardization are enhanced. Conclusions The pandemic has potentially compounded existing bottlenecks to the autism diagnostic pathway. Future research should seek to improve timeliness, standardization, accessibility and robustness of this pathway, and the validity and reliability of telehealth autism assessments.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gavin R. Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridge, United Kingdom
| | - Simone J. Capp
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Höfer J, Hoffmann F, Dörks M, Kamp-Becker I, Küpper C, Poustka L, Roepke S, Roessner V, Stroth S, Wolff N, Bachmann CJ. Health Services Use and Costs in Individuals with Autism Spectrum Disorder in Germany: Results from a Survey in ASD Outpatient Clinics. J Autism Dev Disord 2022; 52:540-552. [PMID: 33728496 PMCID: PMC8813793 DOI: 10.1007/s10803-021-04955-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce. Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed. Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs. In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.
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Affiliation(s)
- Juliana Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Charlotte Küpper
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Stefan Roepke
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Dresden, Germany
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17
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Abrahamson V, Zhang W, Wilson PM, Farr W, Reddy V, Parr J, Peckham A, Male I. Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review. BMJ Open 2021; 11:e051241. [PMID: 34907053 PMCID: PMC8672008 DOI: 10.1136/bmjopen-2021-051241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Waiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including 'grey' literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis. DESIGN We performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011-December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process. RESULTS Based on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development. CONCLUSIONS This theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services. TRIAL REGISTRATION NUMBER NCT04422483.
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Affiliation(s)
| | - Wenjing Zhang
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Patricia M Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - William Farr
- Sussex Community NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Venkat Reddy
- Peterborough Child Development Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Jeremy Parr
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Peckham
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Ian Male
- Sussex Community NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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18
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Zammarchi G, Conversano C. Application of Eye Tracking Technology in Medicine: A Bibliometric Analysis. Vision (Basel) 2021; 5:56. [PMID: 34842855 PMCID: PMC8628933 DOI: 10.3390/vision5040056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Eye tracking provides a quantitative measure of eye movements during different activities. We report the results from a bibliometric analysis to investigate trends in eye tracking research applied to the study of different medical conditions. We conducted a search on the Web of Science Core Collection (WoS) database and analyzed the dataset of 2456 retrieved articles using VOSviewer and the Bibliometrix R package. The most represented area was psychiatry (503, 20.5%) followed by neuroscience (465, 18.9%) and psychology developmental (337, 13.7%). The annual scientific production growth was 11.14% and showed exponential growth with three main peaks in 2011, 2015 and 2017. Extensive collaboration networks were identified between the three countries with the highest scientific production, the USA (35.3%), the UK (9.5%) and Germany (7.3%). Based on term co-occurrence maps and analyses of sources of articles, we identified autism spectrum disorders as the most investigated condition and conducted specific analyses on 638 articles related to this topic which showed an annual scientific production growth of 16.52%. The majority of studies focused on autism used eye tracking to investigate gaze patterns with regards to stimuli related to social interaction. Our analysis highlights the widespread and increasing use of eye tracking in the study of different neurological and psychiatric conditions.
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Affiliation(s)
- Gianpaolo Zammarchi
- Department of Economics and Business Sciences, University of Cagliari, 09123 Cagliari, Italy;
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19
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Rutherford M, Maciver D, Johnston L, Prior S, Forsyth K. Development of a Pathway for Multidisciplinary Neurodevelopmental Assessment and Diagnosis in Children and Young People. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1033. [PMID: 34828746 PMCID: PMC8617836 DOI: 10.3390/children8111033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
There is a variable standard of access to quality neurodevelopmental assessment and diagnosis. People may have negative experiences, encountering lengthy waiting times, and inconsistent practices. Practitioners need guidance on standards and practices for assessment and diagnosis matched to new ways of working. In this paper, we present a new pathway and recommendations for multidisciplinary neurodevelopmental assessment and diagnosis for children and young people (<19 years), developed by the Scottish Government funded National Autism Implementation Team (NAIT). Our research used the Medical Research Council guidance for the development of complex interventions and included several iterative stages. Stage 1: n = 44 stakeholders attended an event on developing new practices for diagnosis and assessment. Stage 2: a literature synthesis was completed by the research team of clinical guidelines and diagnosis and assessment tools. Stage 3: an event with n = 127 stakeholders included discussion and debate of the data from stages 1 and 2. Recommendations and a draft pathway were written. Stage 4: successive drafts of recommendations and the pathway documentation were circulated among an advisory group, including multidisciplinary clinical experts and people with lived experience, until the final pathway was agreed upon. The finalised pathway includes guidance on terminology, assessment, diagnosis, triage, time standards and engagement of people with lived experience. The new pathway has been adopted by the Scottish Government. The pathway and associated documentation are freely available online for use by others.
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Affiliation(s)
- Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh EH8 8BG, UK
| | - Susan Prior
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
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20
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A Longitudinal Study of Features Associated with Autism Spectrum in Clinic Referred, Gender Diverse Adolescents Accessing Puberty Suppression Treatment. J Autism Dev Disord 2021; 51:2068-2076. [PMID: 32936414 DOI: 10.1007/s10803-020-04698-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature has documented inflated rates of features associated with autism spectrum (AS) in clinic referred, gender diverse young people. This study examined scores on the Social Responsiveness Scale, Second Edition (SRS-2) over time in a group of clinic referred, gender diverse adolescents accessing gonadotropin-releasing hormone analogues (GnRHa) to supress puberty. Primary caregivers of 95 adolescents presenting to the Gender Identity Development Service (GIDS) completed the SRS-2 prior to receiving endocrine input (mean age: 13.6 ± SEM: 0.11) and after approximately one year of accessing GnRHa (mean age: 14.6 ± SEM: 0.13). No significant differences in SRS-2 scores over time and between birth assigned sex were found. No interactions between time and birth assigned sex were established for SRS-2 subscales or total scores.
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21
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The Feedback Session of an Autism Assessment: A Scoping Review of Clinical Practice Guideline Recommendations. J Autism Dev Disord 2021; 52:1821-1840. [PMID: 34036417 PMCID: PMC8148412 DOI: 10.1007/s10803-021-05067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/31/2022]
Abstract
This review aimed to assess the quality and content of recommendations for delivering an autism diagnosis, published internationally within clinical practice guidelines. Seventeen relevant guidelines were identified. When methodological information was provided, recommendations for feedback were predominantly formed through consensus. Recommendations consistently included who should attend feedback, the timing and mode of delivery, the clinician's manner, and what should be discussed and/or included in an accompanying report. Specific recommendations were not consistent however, and a number of gaps were identified, such as the inclusion of educators and educational specific recommendations. Although individual variation is necessary for autism diagnosis disclosure, agreement on minimum standards of practice is warranted. Further investigation is required to establish best practice.
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22
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Oshima F, Murata T, Ohtani T, Seto M, Shimizu E. A preliminary study of schema therapy for young adults with high-functioning autism spectrum disorder: a single-arm, uncontrolled trial. BMC Res Notes 2021; 14:158. [PMID: 33926531 PMCID: PMC8082897 DOI: 10.1186/s13104-021-05556-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Psychological problems associated with isolation and mistrust are common among young adults with autism spectrum disorder (ASD). Schema therapy (ST) has recently been shown to be effective against chronic personality problems of various mental disorders, including personality disorders. This pilot clinical trial aimed to explore the feasibility and acceptability of ST in young adults with high-functioning ASD. RESULTS Following the intervention, a significant reduction in early maladaptive schemas and improvements in quality of life and social adjustment were observed. ST may be feasible and is applicable to young adults with HF-ASD. Trial registration UMIN000014535; registered on July 11, 2014.
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Affiliation(s)
- Fumiyo Oshima
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.
| | - Tomokazu Murata
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Toshiyuki Ohtani
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.,Safety and Health Organization, Chiba University, Chiba, Japan
| | - Mikuko Seto
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Eiji Shimizu
- Safety and Health Organization, Chiba University, Chiba, Japan
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23
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Kanne SM, Bishop SL. Editorial Perspective: The autism waitlist crisis and remembering what families need. J Child Psychol Psychiatry 2021; 62:140-142. [PMID: 32384166 DOI: 10.1111/jcpp.13254] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 01/24/2023]
Abstract
Differential diagnosis of autism is very complex. Best practice guidelines in the US encourage the use of specialized tools by a highly trained provider. The need for this comprehensive evaluation, coupled with the increase in autism prevalence and awareness, has led to alarmingly long wait times for diagnostic evaluations. Several solutions are currently being researched to remedy this problem and relieve the pressure, including testing new devices or procedures that can speed up the diagnostic process. Creative solutions are welcomed; however, we urge caution in the use of new devices and methods without being fully vetted. Moreover, a quality assessment provides much more than just a designation of whether or not autism is present. Thus, even in cases when alternative means could be used to more quickly arrive at a diagnosis, a comprehensive assessment with a trained clinician is needed to guide recommendations and ongoing care.
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Affiliation(s)
- Stephen M Kanne
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Somer L Bishop
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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24
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MacLachlan M. Commentary: Challenges and opportunities in autism assessment - a commentary on Kanne and Bishop (2020). J Child Psychol Psychiatry 2021; 62:146-148. [PMID: 33247434 DOI: 10.1111/jcpp.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/27/2022]
Abstract
Kanne and Bishop's (2020) Editorial Perspective 'The Autism waitlist crisis and remembering what families need' offers a strong argument to provide greater access to high-quality assessments for Autism Spectrum Disorder (ASD). They note, correctly, that due to increasing numbers of referrals practitioners are under increasing pressure to provide quicker or abbreviated evaluations, that some cases are extremely complex and require considerable expertise to assess, and that a good assessment is a good investment in effective intervention. I agree with these points but also want to highlight some difficulties and dilemmas associated with the assessment of ASD; and to argue that improving access to assessments and interventions through the use of nonspecialists and new technologies may be a promising direction.
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Affiliation(s)
- Malcolm MacLachlan
- ALL Institute and Department of Psychology, Maynooth University, Maynooth, Ireland.,OUSHI, Palacky University Olomouc, Czech Republic, Czechia, Europe
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25
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Shared Features or Co-occurrence? Evaluating Symptoms of Developmental Coordination Disorder in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 51:3443-3455. [PMID: 33387238 PMCID: PMC10177628 DOI: 10.1007/s10803-020-04766-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination Disorder (DCD). We aimed to determine whether motor problems in ASD represent the possible co-occurrence of DCD. We retrospectively reviewed standardized assessments and parent-reports to evaluate motor ability in 43 individuals with ASD against diagnostic criteria for DCD, and compared to 18 individuals with DCD. Over 97% of cases in the ASD group scored below the 16th percentile in motor ability, with most below the 5th percentile. Over 90% of cases in the ASD group met criteria for co-occurring DCD. Motor challenges are a clinically-significant problem in ASD; systematically assessing the prevalence of co-occurring ASD + DCD is necessary to optimize assessment and intervention.
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26
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Chandrasekhar T. Supporting the needs of college students with autism spectrum disorder. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:936-939. [PMID: 31702974 DOI: 10.1080/07448481.2019.1686003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/20/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Young adults with autism spectrum disorder (ASD) are enrolling in colleges at increasing rates. This case highlights the need for college mental health clinicians to be aware of features of ASD in emerging adults. Participants: A case of a young woman with dysphoria and anxiety who also met ASD criteria during a diagnostic evaluation. Methods: The author describes diagnostic criteria for ASD, common psychiatric co-morbidities, and commonly used campus services. Results: The student in this case was diagnosed with ASD during the course of treatment for dysphoria and anxiety. Knowledge of this diagnosis led to better self-understanding and discovery of new supports. Conclusions: College mental health clinicians will increasingly encounter students with ASD whose social and communication challenges impact their success in post-secondary educational environments. Clinicians should be knowledgeable of ASD features, common mental health challenges, and how best to support students.
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Affiliation(s)
- Tara Chandrasekhar
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Counseling and Psychological Services, Duke University, Durham, NC, USA
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Bernie C, Williams K, O'Connor B, Rogers S, May T. Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting. J Autism Dev Disord 2020; 51:2673-2685. [PMID: 33034784 DOI: 10.1007/s10803-020-04725-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.
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Affiliation(s)
- C Bernie
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia.
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - K Williams
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, 3058, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
| | - B O'Connor
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - S Rogers
- Department of Allied Health, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Health and Human Services, Melbourne, VIC, Australia
| | - T May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
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Fahy R, Corbett M, Keogh I. Improving peri-operative psychosocial interventions for children with autism spectrum disorder undergoing ENT procedures. J Laryngol Otol 2020; 134:1-7. [PMID: 32993840 DOI: 10.1017/s0022215120002029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Children with autism spectrum disorder face a broad range of communication and sensory challenges. Many of these children also have chronic ENT issues. This study aims to better understand these challenges and improve our services for children with autism spectrum disorder. METHODS Questionnaires and semi-structured interviews were carried out with parents of children with autism spectrum disorder. RESULTS Thirty-four individuals participated, comprising 9 caregivers and 25 staff members. All parents recognised their critical roles in understanding their children's special needs and sensitivities. Parents and staff stressed the importance of a partnership role that inquired about unique needs, leading to environmental modifications for individual children. CONCLUSION The importance of listening to and involving caregivers is a fundamental tenet; parents must be recognised as the experts. Uncertainty must be kept to a minimum, with clear communication in a structured, low-arousal environment for these children. We have listened to parents and staff, and developed a social story.
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Affiliation(s)
- R Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, and Academic Department of Otorhinolaryngology, School of Medicine, National University of Ireland, Galway, Ireland
| | - M Corbett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, and Academic Department of Otorhinolaryngology, School of Medicine, National University of Ireland, Galway, Ireland
| | - I Keogh
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, and Academic Department of Otorhinolaryngology, School of Medicine, National University of Ireland, Galway, Ireland
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29
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Jacobs D, Steyaert J, Dierickx K, Hens K. Parents' multi-layered expectations when requesting an Autism Spectrum Disorder assessment of their young child: an in-depth interview study. BMC Psychiatry 2020; 20:440. [PMID: 32912176 PMCID: PMC7488345 DOI: 10.1186/s12888-020-02806-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Parents are valued stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). However, little is known about what drives and moves parents besides their obvious worries and help request when they ask for a diagnostic ASD assessment of their child. METHODS Seventeen Flemish parents of 11 young children participated in a longitudinal study consisting of three in-depth interviews before and after their child's diagnostic ASD assessment. Data were analysed in Nvivo 11 according to the procedures of Interpretative Phenomenological Analysis. RESULTS In this paper we report the results of the first series of interviews which were conducted after parents had asked for an ASD assessment of their young child, and before this assessment started. The pre-assessment experiences of the parents were dominated by the anticipation of various implications of an ASD diagnosis, comprising both positive and negative expectations. The theme of positive expectations consisted of two equally prominent subthemes: treatment-related implications but also expectations pertaining to their psychological and relational experiences. CONCLUSIONS This study suggests important issues for clinicians to bear in mind during a consultation with parents who request an ASD assessment of their young child. We argue that attending to and communicating about parents' expectations prior to their child's ASD assessment may help clinicians to better understand parents' requests for help, and to address their needs more effectively.
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Affiliation(s)
- Delphine Jacobs
- Faculty of Medicine, Centre for Biomedical Ethics and Law - KU Leuven, Kapucijnenvoer 35 box 7001, 3000, Leuven, Belgium.
| | - Jean Steyaert
- Centre for Autism Expertise, Child and Youth Psychiatry - University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kris Dierickx
- Faculty of Medicine, Centre for Biomedical Ethics and Law - KU Leuven, Kapucijnenvoer 35 box 7001, 3000, Leuven, Belgium
| | - Kristien Hens
- Department of Philosophy, Faculty of Arts, University of Antwerp, Prinsstraat 13, 2000, Antwerpen, Belgium
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30
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Clements CC, Sparding T, Schultz RT, Yerys BE, Watkins MW. DAS-II Cognitive Profiles Are Not Diagnostically Meaningful For Autism: A ROC Analysis. Autism Res 2020; 13:2143-2154. [PMID: 32696622 DOI: 10.1002/aur.2336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/08/2020] [Accepted: 05/24/2020] [Indexed: 01/01/2023]
Abstract
Intelligence assessment is an integral part of a comprehensive autism evaluation. Many past studies have described a cognitive profile of autistic individuals characterized by higher nonverbal than verbal IQ scores. The diagnostic utility of this profile, however, remains unknown. We leveraged receiver operating characteristic methods to determine the sensitivity, specificity, and area under the curve (AUC) of three different IQ profiles in a large sample of children who have an autism spectrum disorder diagnosis (N = 1,228, Simons Simplex Collection) who completed the Differential Ability Scales-Second Edition (DAS-II), School Age compared to the normative sample provided by the DAS-II publisher (N = 2,200). The frequently discussed nonverbal > verbal IQ profile performed near chance at distinguishing ASD from normative individuals (AUC: 0.54, 95% CI [0.52-0.56]), and performed significantly worse for females than males (AUC: females: 0.46 [0.41-0.52]; males: 0.55 [0.53-0.58]). All cognitive profiles showed AUC < 0.56. We conclude that while significant differences between verbal and nonverbal IQ scores exist at the group level, these differences are small in an absolute sense and not meaningful at an individual level. We do not recommend using cognitive profiles to aid in autism diagnostic decision-making. LAY SUMMARY: Some researchers and clinicians have reported an "autistic cognitive profile" of higher nonverbal intelligence than verbal intelligence. In an analysis of over 1,000 autistic children, we found that the group's average nonverbal intelligence is usually higher than their verbal intelligence. However, this pattern should not be used by clinicians to make an individual diagnosis of autism because our results show it is not helpful nor accurate.
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Affiliation(s)
- Caitlin C Clements
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Psychology Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert T Schultz
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin E Yerys
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marley W Watkins
- Department of Educational Psychology, Baylor University, Waco, Texas, USA
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31
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Küpper C, Stroth S, Wolff N, Hauck F, Kliewer N, Schad-Hansjosten T, Kamp-Becker I, Poustka L, Roessner V, Schultebraucks K, Roepke S. Identifying predictive features of autism spectrum disorders in a clinical sample of adolescents and adults using machine learning. Sci Rep 2020; 10:4805. [PMID: 32188882 PMCID: PMC7080741 DOI: 10.1038/s41598-020-61607-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
Diagnosing autism spectrum disorders (ASD) is a complicated, time-consuming process which is particularly challenging in older individuals. One of the most widely used behavioral diagnostic tools is the Autism Diagnostic Observation Schedule (ADOS). Previous work using machine learning techniques suggested that ASD detection in children can be achieved with substantially fewer items than the original ADOS. Here, we expand on this work with a specific focus on adolescents and adults as assessed with the ADOS Module 4. We used a machine learning algorithm (support vector machine) to examine whether ASD detection can be improved by identifying a subset of behavioral features from the ADOS Module 4 in a routine clinical sample of N = 673 high-functioning adolescents and adults with ASD (n = 385) and individuals with suspected ASD but other best-estimate or no psychiatric diagnoses (n = 288). We identified reduced subsets of 5 behavioral features for the whole sample as well as age subgroups (adolescents vs. adults) that showed good specificity and sensitivity and reached performance close to that of the existing ADOS algorithm and the full ADOS, with no significant differences in overall performance. These results may help to improve the complicated diagnostic process of ASD by encouraging future efforts to develop novel diagnostic instruments for ASD detection based on the identified constructs as well as aiding clinicians in the difficult question of differential diagnosis.
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Affiliation(s)
- Charlotte Küpper
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Florian Hauck
- Department of Information Systems, Freie Universität Berlin, Berlin, Germany
| | - Natalia Kliewer
- Department of Information Systems, Freie Universität Berlin, Berlin, Germany
| | - Tanja Schad-Hansjosten
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, University Medical Center, Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Katharina Schultebraucks
- Department of Psychiatry, New York University School of Medicine, New York, USA.,Vagelos School of Physicians and Surgeons, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol 2020; 19:434-451. [PMID: 32142628 DOI: 10.1016/s1474-4422(20)30034-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Abstract
Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.
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[ADI-R and ADOS and the differential diagnosis of autism spectrum disorders: Interests, limits and openings]. Encephale 2019; 45:441-448. [PMID: 31495549 DOI: 10.1016/j.encep.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Current developments in international public health are leading qualified authorities to release clinical practice guidelines for Autism Spectrum Disorders (ASD) assessment and diagnosis. Such documents incorporate procedures that rely on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) which are considered to be the "gold standard" assessment measures in the evaluation of ASD. Although these tools do prove their effectiveness in the evaluation of autistic symptomatology, they nevertheless stumble whenever the situation becomes more complex and reveal differential diagnostic issues in infantile and adult autism cases. This differential diagnostic issue remains significant in the clinical practice of daily life and has strong implications for the course of therapeutic treatment. OBJECTIVES Our objective is to underline and nuance the metrological qualities of the ADI-R and the ADOS in the differential diagnosis of autistic disorders by presenting a synthesis of recent studies, thus supporting the interest of maintaining an open debate on diagnostic practices. METHODS Our selective review of the recent literature focuses on studies that confront the ADI-R and the ADOS - used either independently or in a combination - with various differential issues in adulthood and childhood autism in order to highlight their qualities and limits. RESULTS The ADI-R is a semi-structured interview applied by trained examiners and applied to relatives and/or caregivers who collect developmental information about the patient's first years of life on a variety of behaviors and skills. It is therefore relatively dependent on the availability and personal bias of the interviewed third parties. Metric features highlighted by the reviewed studies straightforwardly reveal a certain effectiveness of the tool and a good discrimination of childhood disorders. At the same time, the tool's discriminatory capacity seems insufficient when applied to toddlers, very young children, and adults alike. The latter seems particularly true when it comes to differentiating between autistic and schizophrenic spectrum disorders. The ADOS is a semi-structured standardized observation assessment tool that has experienced several successive developments, such as optimizations concerning the sensitivity of its cutoffs. Many works have contributed to building such a tool with reliable and solid metric qualities which nevertheless retain important biases such as the subjectivity of the caregiver or the evaluator during the scoring process. For assessments of autistic children the tool still has a good diagnostic validity but seems to retain cases of incorrect diagnosis of ASD (false positives). In other words, disorders or developmental disabilities of some children and adolescents could not be distinguished from ASD when relying on this test alone. The ADOS Module 4, designed for the diagnosis of adolescents and adults with fluent speech, has undergone less updating. This revisited algorithm has metrological qualities useful for clinicians and remains one of the few available tools for this population. Unfortunately, its diagnostic accuracy is lower when applied to women, the elderly, people with personality disorders or higher intellectual abilities, or for the discrimination between ASD and schizophrenia. Overall, scores from these two instruments bring strong evidence of their usefulness in the diagnostic process of ASD, provided that they are used with caution and a critical clinical perspective, and only as a secondary technical support. Their use in combination is effective since they are complementary and compensate for each other's limitations. However, their globalized hegemony as "gold-standard" tools constitutes a setback insofar as it constrains the diagnosis of ASD to a set of stereotyped items. The latter in turn sets a normative model of autism that excludes other phenotypic forms, especially in the case of women and the elderly. Finally, the discrimination between autism and psychosis for children seems to remain an insoluble task even for the ADI-R/ADOS combination. CONCLUSIONS The problematics of differential diagnosis remain critical for clinical approaches to autism. Therefore, formalizations of the diagnostic procedures must be able to remain open-minded and accompanied by a creative clinical approach, especially in the case of complex situations that are not soluble by means of conventional diagnostic tools. One possibility may lie in the deepening of the phenomenological approach to autism as an attempt to model the subjective phenomena of autistic subjects and thus operationalize elements that serve the diagnostic process. In the same way, a psychodynamic epistemology could help clinicians to go beyond the consideration of observable behaviors and scores, introducing a psychoanalytic point of view that interfaces objective behaviors with the individual's dynamic intrapsychic functioning. This project could be articulated with projective methodologies - notably the Rorschach test - which respects the needs for standardization and quantification of conventionally used diagnostic tools.
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Timimi S, Milton D, Bovell V, Kapp S, Russell G. Deconstructing Diagnosis: Four Commentaries on a Diagnostic Tool to Assess Individuals for Autism Spectrum Disorders. AUTONOMY (BIRMINGHAM, ENGLAND) 2019; 1:AR26. [PMID: 31396391 PMCID: PMC6687500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diagnostic assessment tools are widely used instruments in research and clinical practice to assess and evaluate autism symptoms for both children and adults. These tools typically involve observing the child or adult under assessment, and rating their behaviour for signs or so-called symptoms of autism. In order to examine how autism diagnosis is constructed, how diagnostic tools are positioned, and how their trainings are delivered, we paid for four places on a training course for a diagnostic tool. We asked the attendees (the first four authors) to each produce a critical commentary about their impressions of the training and the diagnostic tool itself. Their commentaries are published here in full. They have various disciplinary backgrounds: one is a social scientist, one an ethicist, one a psychiatrist, and one a developmental psychologist. The commentaries are followed by a concluding section that summarises the themes, commonalities, and differences between their accounts of the training course. Authors differed as to whether the diagnostic tool is a useful and necessary endeavour. Nevertheless, all critiqued of the tool's lack of transparency, recognizing context, emotion, and differences in interpretation and power imbalances as playing an unidentified role in the assessment process. Based on this project, we recommend that training for raters for such tools should be accessible to a wider group of people, and incorporate more explicit recognition of its own limitations and commercialisation.
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