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Carroll HM, Thom RP, McDougle CJ. The differential diagnosis of autism spectrum disorder in adults. Expert Rev Neurother 2025:1-14. [PMID: 40202215 DOI: 10.1080/14737175.2025.2490533] [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: 09/10/2024] [Revised: 03/25/2025] [Accepted: 04/04/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION Diagnosing autism spectrum disorder (ASD) in adults is challenging due to its heterogeneity and symptom overlap with other conditions. Making an accurate diagnosis can be difficult and overwhelming but is vital for proper accommodations and interventions while avoiding unproductive or harmful treatments. AREAS COVERED The authors have based their review on a comprehensive literature search using PubMed, PsycINFO, and Google Scholar to identify relevant recommendations, diagnostic tools, and common differential diagnoses for adults with ASD. A clinical framework is provided based on the DSM-5 criteria, starting with an evaluation of childhood symptom onset and persistent manifestations of the core criteria - social and communication impairment, along with restricted, repetitive behaviors. Conditions with overlapping presentations, including personality disorders, anxiety, depression, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and schizophrenia, are discussed, as well as challenges in differentiating these from ASD. EXPERT OPINION Many factors complicate diagnosing ASD in adults - such as skewed public perception or misinformation spread on social media. Existing tools frequently miss subtle or atypical presentations, particularly in underdiagnosed groups like women and older adults. Promising advances in machine learning and artificial intelligence will hopefully improve diagnostic precision in the future. Up-to-date clinician training and large-scale research remain paramount for refining adult ASD diagnosis.
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Affiliation(s)
- Hannah M Carroll
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Robyn P Thom
- Department of Psychiatry, Lurie Center for Autism, Harvard Medical School, Massachusetts General Hospital, Lexington, MA, USA
| | - Christopher J McDougle
- Department of Psychiatry, Lurie Center for Autism, Harvard Medical School, Massachusetts General Hospital, Lexington, MA, USA
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Wong KL, Chau SK, Lee SL. Sleep Problems in Children With Developmental Delays and Neurodevelopmental Comorbidities: A Retrospective Cross-Sectional Study. Cureus 2025; 17:e76837. [PMID: 39897271 PMCID: PMC11787621 DOI: 10.7759/cureus.76837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
Background Sleep disturbances are more common in children with developmental delay (DD) than in typically developing children. There is limited research on whether sleep impact is more pronounced in children with DD and comorbidities. Objective Our study compared sleep patterns and disturbances in children with DD and neurological or psychobehavioral comorbidities to those with isolated DD. Methodology We conducted a single-center retrospective study utilizing a parent-rated questionnaire on neurodevelopmental clinic attendees over six months. Subjects were categorized into three groups: (1) isolated DD; (2) DD with comorbid neurological conditions; and (3) DD with comorbid psychobehavioral conditions. Results A total of 529 subjects were included. The results revealed minimal differences in sleep schedules between the groups. More than half of the sample (276, 52.2%) had insufficient sleep hours, with no significant variation across groups. A substantial proportion of the sample took regular naps, with 340 (79.3%) on weekdays and 279 (69.9%) on weekends. Compared to the isolated DD group, the comorbid neurological group showed a higher sleep resistance score, while comorbid psychobehavioral conditions were associated with higher sleep resistance scores and lower sleep parasomnia scores. A lower portion of the comorbid neurological group had their parents satisfied with their sleep quality (16, 32.7%, vs. 121, 52.2%). A higher percentage of parents in the comorbid psychobehavioral group reported significant daily life impact due to their children's sleep problems (65, 28.0%, vs. 41, 17.1%). Conclusions The sleep schedule in all three groups closely resembled each other. All three groups exhibited a high prevalence of sleep-related problems. Regular screening for sleep problems is recommended, particularly for children with DD and neurological or psychobehavioral comorbidities.
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Affiliation(s)
- Kin Lok Wong
- Paediatrics, Queen Elizabeth Hospital, Kowloon, HKG
| | - Shuk Kuen Chau
- Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, HKG
| | - So Lun Lee
- Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, HKG
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Accardo AL, Pontes NMH, Pontes MCF. Greater Physical Activity is Associated with Lower Rates of Anxiety and Depression Among Autistic and ADHD Youth: National Survey of Children's Health 2016-2020. J Autism Dev Disord 2024; 54:4006-4018. [PMID: 37751090 DOI: 10.1007/s10803-023-06117-0] [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: 08/15/2023] [Indexed: 09/27/2023]
Abstract
Data from the National Survey of Children's Health 2016-2020 was used to examine the association between physical activity and anxiety and depression among autistic youth, non-autistic youth with ADHD, and non-autistic non-ADHD youth. There was a significant negative association between physical activity and anxiety among all groups. Reduction in anxiety or depression associated with greater physical activity was at least as large or larger among autistic or nonautistic youth with ADHD than among non-autistic non-ADHD youth. Unfortunately, even autistic youth who were physically active 4 to 7 days a week showed very high rates of anxiety (54.5%) and depression (23.1%). Very high levels of dual diagnosis of anxiety and depression in autistic youth and youth with ADHD also emerged. Findings highlight a need to determine the cause-and-effect relationships among physical activity, anxiety, and depression across groups and to prioritize mental health screenings and support for autistic youth and youth with ADHD.
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Affiliation(s)
- Amy L Accardo
- College of Education, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
| | - Nancy M H Pontes
- School of Nursing, Rutgers University, 530 Federal Street, Camden, NJ, 08102, USA
| | - Manuel C F Pontes
- Rohrer College of Business, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
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Xing J, Wei R, Wang H, Hua Z, Tang X, Yi L, Li X, Liu J. Symptoms of ADHD and Autism Spectrum Disorder Interactively Predict Children's Verbal Fluency. J Atten Disord 2024; 28:1092-1104. [PMID: 38353406 DOI: 10.1177/10870547241232081] [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: 04/14/2024]
Abstract
OBJECTIVE Verbal fluency, the capacity to generate words from a designated category, predicts myriad cognitive and life outcomes. The study investigated verbal fluency in children with ADHD, autism spectrum disorder (ASD), and comorbid ADHD and ASD, to understand how ADHD- and ASD-related symptoms individually and jointly predict verbal fluency, and the underlying linguistic and cognitive substrates. METHOD Thirty-three school-aged children with ADHD, 27 with ASD, 25 with comorbid ADHD and ASD, and 39 with typical development, were assessed for ADHD and ASD symptoms and completed a semantic verbal fluency task. RESULTS Findings indicated that ADHD and ASD symptoms, especially ADHD hyperactivity-impulsivity symptoms and language-related ASD symptoms, interactively predicted verbal fluency across diagnostic groups. CONCLUSION The study implicated the potential cognitive and linguistic mechanisms underlying verbal fluency differences in ADHD and/or ASD, and clinical practices on enhancing verbal fluency in these clinical groups.
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Affiliation(s)
| | - Ran Wei
- Peking University, Beijing, China
| | - Hui Wang
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | | | - Xinzhou Tang
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Li Yi
- Peking University, Beijing, China
| | - Xue Li
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing Liu
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Kentrou V, Livingston LA, Grove R, Hoekstra RA, Begeer S. Perceived misdiagnosis of psychiatric conditions in autistic adults. EClinicalMedicine 2024; 71:102586. [PMID: 38596613 PMCID: PMC11001629 DOI: 10.1016/j.eclinm.2024.102586] [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: 05/03/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Many autistic people, particularly women, do not receive an autism diagnosis until adulthood, delaying their access to timely support and clinical care. One possible explanation is that autistic traits may initially be misinterpreted as symptoms of other psychiatric conditions, leading some individuals to experience misdiagnosis of other psychiatric conditions prior to their autism diagnosis. However, little is currently known about the frequency and nature of psychiatric misdiagnoses in autistic adults. Methods Using data collected in the first half of 2019 from an ongoing longitudinal register of autistic adults in the Netherlands, this study explored the frequency of perceived psychiatric misdiagnoses before receiving an autism diagnosis. Gender differences were also explored. A sample of 1211 autistic adults (52.6% women, mean age 42.3 years), the majority of whom were Dutch and relatively highly educated, was evaluated. Findings Results showed that 24.6% (n = 298) of participants reported at least one previous psychiatric diagnosis that was perceived as a misdiagnosis. Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder. Autistic women (31.7%) reported perceived misdiagnoses more frequently than men (16.7%). Women were specifically more likely than men to report perceived misdiagnoses of personality disorders, anxiety disorders, and mood disorders. Women also reported prior psychiatric diagnoses more often in general (65.8% versus 34.2% in men). Within the group of individuals with a prior diagnosis, perceived misdiagnoses were equally likely for men and women. Interpretation One in four autistic adults, and one in three autistic women, reported at least one psychiatric diagnosis, obtained prior to being diagnosed with autism, that was perceived as a misdiagnosis. Inaccurate diagnoses are linked to long diagnostic pathways and delayed recognition of autism. These findings highlight the need for improved training of mental health practitioners, in order to improve their awareness of the presentation of autism in adulthood and of the complex relationship between autism and co-occurring conditions. The current study constitutes a first step towards showing that autistic adults, and particularly women, may be at greater risk of experiencing misdiagnoses. Future studies based on larger, more representative samples are required, to replicate current findings and provide more reliable estimates of the overall frequency of misdiagnoses as well as the frequency of misdiagnoses for specific psychiatric conditions. Funding This study was made possible by funding from the Netherlands Organisation for Health Research and Development (ZonMW), project number 60-63600-98-834.
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Affiliation(s)
- Vasiliki Kentrou
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lucy A Livingston
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Grove
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sander Begeer
- Department of Clinical Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Wilson RB, Thompson AR, Rowse G, Smith R, Dugdale AS, Freeth M. Autistic women's experiences of self-compassion after receiving their diagnosis in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1336-1347. [PMID: 36373832 PMCID: PMC10291390 DOI: 10.1177/13623613221136752] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Knowledge of autistic individuals' experiences of self-compassion is very limited. This study investigated autistic women's experiences of self-compassion after receiving their diagnosis in adulthood. Eleven autistic women were interviewed about their experiences of receiving their diagnosis in adulthood and their experiences of self-compassion. Systematic analysis of the interview transcripts revealed common themes in the participants' experiences. Participants reported that their autism diagnosis helped them to better understand themselves, particularly when reflecting on problematic past experiences. After receiving an autism diagnosis, participants described being able to relate to themselves with greater self-kindness compared to previous self-criticism; this included allowing themselves to assert their needs and engage in self-care activities. Participants spoke about having difficult social experiences, including feeling pressure to conform to expectations in society and often feeling misunderstood. The findings highlight the barriers autistic women face obtaining their diagnoses and demonstrate the need for autism training for professionals to support early identification. Findings from this study suggest that interventions aimed at developing self-compassion could support and enhance autistic women's well-being.
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Affiliation(s)
| | | | | | - Richard Smith
- Derbyshire Community Health Services, NHS Foundation Trust, UK
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Tincani M, Ji H, Upthegrove M, Garrison E, West M, Hantula D, Vucetic S, Dragut E. Vocational Interventions for Individuals with ASD: Umbrella Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Ahmed SK, Jeffries D, Chakraborty A, Carslake T, Lietz P, Rahayu B, Armstrong D, Kaushik A, Sundarsagar K. Teacher professional development for disability inclusion in low- and middle-income Asia-Pacific countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1287. [PMID: 36908831 PMCID: PMC9700054 DOI: 10.1002/cl2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background In the Asia-Pacific region, around one-third of the children who are out-of-school have a disability and given that teacher readiness and capability are key contributors for inclusive education, it is high time for a mapping of disability inclusive teacher professional development (TPD) interventions in this region. Objectives The key objective of this evidence and gap map (EGM) is to locate evidence on interventions for in-service TPD focussing on education for the inclusion of students with a disability in low- and middle-income countries (LMICs) in the Asia-Pacific region. Search Methods A broad range of bibliographic databases and repositories were searched electronically to identify the evidence published between January 2000 and December 2021. Key search platforms included the British Education Index (BEI), Education Research Complete (ERC), Education Resources Information Center (ERIC), SCOPUS, 3ie Development Evidence Portal (Evidence Hub) and the Campbell Collaborations Systematic Reviews and EGMs portal (Better evidence for a better world). In addition, potential program evaluations/impact reports, reviews, case studies, and program descriptions/summaries were sought through 'snowballing' based on searching bibliographies and reference lists of papers located during the search process, as well as specific searches of relevant grey literature. Selection Criteria To be eligible for inclusion, studies had to contain sufficient details about TPD interventions that support early childhood educators and kindergarten to Year 12 teachers to understand the needs of students with disabilities and aid them to create inclusive mainstream classrooms and/or provide improved support for students with disabilities in special education settings. Data Collection and Analysis A total of 820 records were entered into the MS Excel file in which the entire data extraction process was managed. All records were screened against the predefined inclusion and exclusion criteria. Data were extracted independently by two reviewers and any differences were resolved through consultations. All included studies and their characteristics were extracted from the MS Excel file and uploaded to the ACER server in.csv file format. The interactive, online EGM is available here: https://datavis.acer.org/gem/disability-inclusion-TPD/. Main Results Fifty studies from 16 countries out of the 41 LMICs in the Asia-Pacific region were identified, whereby Thailand had the largest number of studies with evidence (7) followed by China, Vietnam, and India (5 each). Two main gaps in research about professional learning were identified. First, only three studies reported interventions aimed at supporting mental health among students with a disability. Second, no studies were found that reported on how teachers could support positive student behaviour. These gaps are important because research has persistently suggested that experiencing disability is an important risk factor for young people developing mental health conditions. Authors' Conclusions This report illustrates the critical value of evaluating and publishing evidence from disability inclusive TPD interventions in LMICs, including any that are ongoing, or are components of highly resource intensive large-scale education sector programs.
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Affiliation(s)
| | - David Jeffries
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | | | - Toby Carslake
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | | | | | - Amit Kaushik
- Australian Council for Educational ResearchNew DelhiIndia
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9
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Billeiter KB, Froiland JM, Allen JP, Hajovsky DB. Neurodiversity and Intelligence: Evaluating the Flynn Effect in Children with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2022; 53:919-927. [PMID: 33939111 DOI: 10.1007/s10578-021-01175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
The Flynn Effect (FE) among child and adolescent populations indicates that intelligence scores improve by about three points per decade. Using nine years of data from the National Database for Autism Research, this study examined whether general intelligence changed significantly for nine cohorts with autism spectrum disorder (ASD; N = 671). Analyses demonstrated a downward trend such that Cohen's d from 1998 to 2006 was - 0.27. The mean IQ is 92.74 for years 1-3, 91.54 for years 4-6, and 87.34 for years 7-9, indicating a reverse FE of 5.4 points per decade. A linear regression revealed a significant negative FE comparable to the positive effect of age on IQ among those with ASD. Implications for research, practice, and law are discussed.
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Affiliation(s)
| | - John Mark Froiland
- Department of Educational Studies, Purdue University, West Lafayette, IN, USA
| | - Justin P Allen
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | - Daniel B Hajovsky
- Division of Counseling and Psychology in Education, University of South Dakota, Vermillion, SD, USA
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Sakdalan J, Maxwell Y. The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.
Design/methodology/approach
This is a conceptual paper that includes a case vignette.
Findings
A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.
Research limitations/implications
It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.
Practical implications
Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.
Originality/value
There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
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Lanyi J, Mannion A, Chen JL, Leader G. Relationship between Comorbid Psychopathology in Children and Adolescents with Autism Spectrum Disorder and Parental Well-being. Dev Neurorehabil 2022; 25:151-161. [PMID: 33998371 DOI: 10.1080/17518423.2021.1922529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Frequency and relationship between child comorbid psychopathology and parental stress, quality of life (QoL), anxiety, depression, and social support were examined in parents of children and adolescents with autism spectrum disorder (ASD). METHOD Parents of 152 children and adolescents with ASD completed the Autism Spectrum Disorder-Comorbid for Children, Parenting Stress Index-Short Form, World Health Organization Quality of Life Abbreviated Version, Hospital Anxiety and Depression Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS A series of one-way multivariate analysis of variance was conducted to examine the relationship between child comorbid psychopathology and parental well-being. A relationship was found between parental QoL, depression and anxiety and child comorbid psychopathology. Results showed a relationship between parental stress and the severity of child conduct, and repetitive behaviors. CONCLUSION This study adds to existing literature by demonstrating the relationship between comorbid psychopathology in children and adolescents in ASD and parental well-being.
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Affiliation(s)
- Julia Lanyi
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Arlene Mannion
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - June L Chen
- Department of Special Education, Faculty of Education, East China Normal University, Shanghai, China
| | - Geraldine Leader
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
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12
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Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis. World J Psychiatry 2021; 11:1366-1386. [PMID: 35070783 PMCID: PMC8717043 DOI: 10.5498/wjp.v11.i12.1366] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Differential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD), but clinical assessments often omit screening for personality disorders (PD), which are especially common in individuals with high-functioning ASD where there is less need for support. AIM To summarize the research findings on PD in adults with ASD and without intellectual disability, focusing on comorbidity and differential diagnosis. METHODS PubMed searches were performed using the key words "Asperger's Syndrome", "Autism", "Personality", "Personality disorder" and "comorbidity" in order to identify relevant articles published in English. Grey literature was identified through searching Google Scholar. The literature reviews and reference sections of selected papers were also examined for additional potential studies. The search was restricted to studies published up to April 2020. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria: 16 evaluated personality profiles or PD in ASD (comorbidity), five compared ASD and PD (differential diagnosis) and one performed both tasks. There were significant differences in the methodological approaches, including the ASD diagnostic instruments and personality measures. Cluster A and cluster C PD are the most frequent co-occurring PD, but overlapping features should be considered. Data on differential diagnosis were only found with cluster A and cluster B PD. CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Further studies are needed to explore the complex relationship between ASD and PD.
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Affiliation(s)
- Camilla Rinaldi
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
| | - Margherita Attanasio
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Monica Mazza
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Roberto Keller
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
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13
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Ahmed SK, Jeffries D, Chakraborty A, Lietz P, Kaushik A, Rahayu B, Armstrong D, Sundarsagar K. PROTOCOL: Teacher professional development for disability inclusion in low- and middle-income Asia-Pacific countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1201. [PMID: 36950346 PMCID: PMC8988775 DOI: 10.1002/cl2.1201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
According to prior research, teacher readiness and capability are key contributors for successful transition towards disability inclusive education, yet in-service teacher professional development for disability inclusion remains an under-researched area. The key objective of this evidence and gap map (EGM) is to locate evidence on interventions for disability inclusion focused teacher professional development (TPD) in low-to-middle-income-countries (LMICs) in the Asia-Pacific region. As such, it will illustrate different levels of evidence for TPD interventions as well as where there is no evidence (i.e., gaps). In other words, the EGM can make agencies aware where they might be operating in an area that is evidence-free or evidence-weak so they can take up interventions that are evidence-based or collect evidence for the intervention they are presently supporting. Thus, the ultimate goal for the EGM is to assist funders and implementing agencies when making decisions as to how to support LMICs in the region to reach their aim of developing quality teachers for the global inclusive education agenda (target SDG 4.c).
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Affiliation(s)
- Syeda K. Ahmed
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - David Jeffries
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | | | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Amit Kaushik
- Australian Council for Educational ResearchNew DelhiIndia
| | | | - David Armstrong
- RMIT University School of EducationBundooraVictoriaAustralia
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Lipinski S, Boegl K, Blanke ES, Suenkel U, Dziobek I. A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1509-1521. [PMID: 34825580 PMCID: PMC9344568 DOI: 10.1177/13623613211057973] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most adults on the autism spectrum have co-occurring mental health
conditions, creating a high demand for mental health services –
including psychotherapy – in autistic adults. However, autistic adults
have difficulties accessing mental health services. The most-reported
barriers to accessing treatment are therapists’ lack of knowledge and
expertise surrounding autism, as well as unwillingness to treat
autistic individuals. This study was conducted by a participatory
autism research group and examined 498 adult-patient psychotherapists
on knowledge about autism and self-perceived competency to diagnose
and treat autistic patients without intellectual disability compared
to patients with other diagnoses. Psychotherapists rated their
education about autism in formal training, and competency in the
diagnosis and treatment of patients with autism, lowest compared to
patients with all other diagnoses surveyed in the study, including
those with comparable prevalence rates. Many therapists had
misconceptions and outdated beliefs about autism. Few had completed
additional training on autism, but the majority were interested in
receiving it. Greater knowledge about autism was positively linked to
openness to accept autistic patients. The results point to an alarming
gap in knowledge necessary for adequate mental health care for
individuals with autism.
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Affiliation(s)
| | | | - Elisabeth S Blanke
- Humboldt-Universität zu Berlin, Germany.,Friedrich-Schiller-Universität, Germany
| | | | - Isabel Dziobek
- Humboldt-Universität zu Berlin, Germany.,Charité - Universitätsmedizin Berlin, Germany.,Freie Universität Berlin, Germany.,Berlin Institute of Health, Germany
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15
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Shanahan PJ, Isaac M, Blackwell JE. Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder: a pragmatic approach to assessment and management. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management.
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16
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Rosello R, Martinez-Raga J, Mira A, Girela B, Cortese S. Developmental outcomes in adolescence of children with autism spectrum disorder without intellectual disability: A systematic review of prospective studies. Neurosci Biobehav Rev 2021; 126:590-603. [PMID: 33872683 DOI: 10.1016/j.neubiorev.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) without intellectual disability (ID) represent approximately two-thirds of the ASD population. Here we focused on prospective research assessing different areas of functioning of children with ASD, without ID, until adolescence. Based on a pre-registered protocol (PROSPERO CRD42020189029), a systematic review of prospective studies (published between 01.01.2010 and 01.01.2020) was conducted. Twenty-eight studies met eligibility criteria. Findings indicated that ASD diagnosis and the Intelligence Quotient were highly stable over time across studies. Executive Functioning, Theory of Mind and Central Coherence processes tended to improve, although deficits remained when compared to typically developed controls. Adaptive difficulties and psychiatric comorbidity were relatively stable over time. We discuss potential implications of the findings for clinicians and educators and suggest recommendations for future research.
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Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Imperial College London, UK.
| | - Jose Martinez-Raga
- Psychiatry Department, University Hospital Doctor Peset of Valencia & University of Valencia, Spain
| | - Alvaro Mira
- Division of Developmental and Educational Psychology, University of Valencia, Spain
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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17
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Frigaux A, Lighezzolo-Alnot J, Maleval JC, Evrard R. Clinique différentielle du spectre de l’autisme : l’intérêt de penser un « autisme ordinaire ». EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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18
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Prosperi M, Turi M, Guerrera S, Napoli E, Tancredi R, Igliozzi R, Apicella F, Valeri G, Lattarulo C, Gemma A, Santocchi E, Calderoni S, Muratori F, Vicari S. Sex Differences in Autism Spectrum Disorder: An Investigation on Core Symptoms and Psychiatric Comorbidity in Preschoolers. Front Integr Neurosci 2021; 14:594082. [PMID: 33584212 PMCID: PMC7876072 DOI: 10.3389/fnint.2020.594082] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Findings regarding sex differences in autism spectrum disorder (ASD), as far as core symptoms and psychiatric comorbidities (PC) are concerned, are inconsistent, inconclusive, or conflicting among studies. The lower prevalence of ASD in females than in males and the age and intelligence quotient (IQ) heterogeneity among samples made it difficult to investigate these differences. This case–control study tries to deepen the impact of sex differences on core symptoms of autism and PC in 214 preschoolers with ASD (mean age, 45.26) without impairment in non-verbal IQ (nvIQ ≥70). A total of 107 ASD females (mean age, 44.51 ± 13.79 months) were matched one by one with 107 males (mean age, 46.01 ± 13.42 months) for chronological age (±6 months) and nvIQ (±6 points). We used the Autism Diagnostic Observation Schedule 2 (ADOS-2) and the Child Behavior Checklist (CBCL) 1.5–5 to explore autism severity and PC. The results highlight that ASD females did not significantly differ from ASD males regarding the severity of autism. Statistically significant lower levels of emotionally reactive (p = 0.005, η2 = 0.04), anxious-depressed (p = 0.001, η2 = 0.05), internalizing problems (p = 0.04, η2 = 0.02), and DSM-Oriented Scales anxiety problems (p = 0.02, η2 = 0.04) in ASD females than in ASD males were also detected. Our findings of no difference in the autism severity and lower internalizing problems in females than males with ASD extend the knowledge of autism in females during preschool years. Compared to other similar studies on this topic, we can state that these results are not supported by differences in nvIQ between sexes nor by the presence of cognitive impairment. It confirms the need for clinicians to consider sex differences when describing autism psychopathology.
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Affiliation(s)
- Margherita Prosperi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Turi
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Eleonora Napoli
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Raffaella Tancredi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Roberta Igliozzi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Fabio Apicella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Valeri
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | | | - Andrea Gemma
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.,Institute of Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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19
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Alaghband-rad J, Jamaloo S, Motamed M. Roozbeh adult autism spectrum disorder clinic: lessons learned from first 34 cases. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:766-772. [PMID: 36210907 PMCID: PMC9542341 DOI: 10.1080/20473869.2020.1855691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/16/2023]
Abstract
Autism Spectrum Disorder (ASD) is a complex heterogeneous clinical entity with many overlaps and comorbidities with other psychiatric and developmental disorders. Adults with ASD lack adequate access to facilities and supports. This article describes the clinical profile of the first 34 patients admitted to Roozbeh adult ASD clinic during a 12-month period. Twenty-eight patients were male, all were single, 22 patients were unemployed and 26 were living with their families of origin. Obsession, inattention and sexual problems were the most common chief complaints. Multifaceted and gender-specific presentations results in misdiagnoses. Knowledge and training of the mental health professionals on adult ASD seem to be seriously inadequate. There is virtually no other specialized clinical and rehabilitation facilitates to help this vulnerable group of patients in Iran.
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Affiliation(s)
- Javad Alaghband-rad
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
| | - Samira Jamaloo
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
| | - Mahtab Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
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20
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Assessment of Changes over Time of Lipid Profile, C-Reactive Protein Level and Body Mass Index in Teenagers and Young Adults on Different Diets Belonging to Autism Spectrum Disorder. Nutrients 2020; 12:nu12092594. [PMID: 32859040 PMCID: PMC7551291 DOI: 10.3390/nu12092594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Numerous scientific studies on patients with autism spectrum disorder (ASD) suggest a significant role of inflammation processes or lipid disorders in this spectrum of neurodevelopmental disorders. Unfortunately, there is a lack of assessments of changes over time regarding level of lipids and inflammatory markers in people diagnosed with ASD using different diets. The aim of this study was to evaluate changes in lipid profile, high sensitivity C-reactive protein (hs-CRP) and body mass index (BMI) in individuals diagnosed with ASD and healthy controls. Variables were assessed at two time points (2015/17 and 2017/20) for each subject. Methods: After applying the selection criteria, for the first assessment period, 96 participants were qualified (the group consisted of 59 males with ASD and 37 healthy volunteers, i.e., age-matched control group—CG). The final assessment included 93 participants (57 from ASD group and 36 from CG). Subjects were on low-fat diet (LFD), gluten–casein-free diet (GF–CF) and regular diet (RD), respectively. All members of CG were on regular diet. A fasting lipid profile and hs-CRP level were analyzed. BMI and percentiles were calculated. Eating habits were checked by analyzing data from questionnaires. Principal component analysis (PCA) was used separately for every assessment. The Mann–Whitney U test was used to compare the medians of variables in the scheme of pairwise comparisons between control and ASD groups on different diets for separate assessment, while differences over time between variables were tested by Wilcoxon signed-rank test. Results: Statistically significant differences between BMI, CRP, triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), non-HDL-C and TC/HDL ratio were found in ASD group in comparison to healthy volunteers (increased BMI, CRP and TC/HDL and decreased HDL-C for all types of diets, increased TG in the group of LFD and RD individual and increased non-HDL-C in the group of GF–CF and RD individuals) during the first assessment period. The second assessment over time also showed increased levels of TC, non HDL-C and TC/HDL and decreased level of HDL-C for all ASD individuals regardless of diets used, while BMI and CRP increased only for individuals on LFD and RD. No statistically significant correlations between age of participants and other variables comparing with CG were found. Conclusions: Our studies suggest that targeted, individualized nutritional pattern and periodic screening for lipid and immune disorders would be beneficial for teenagers and adults diagnosed with ASD.
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21
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England-Mason G. Emotion Regulation as a Transdiagnostic Feature in Children with Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00200-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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22
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Tang S, Sun N, Floris DL, Zhang X, Di Martino A, Yeo BTT. Reconciling Dimensional and Categorical Models of Autism Heterogeneity: A Brain Connectomics and Behavioral Study. Biol Psychiatry 2020; 87:1071-1082. [PMID: 31955916 DOI: 10.1016/j.biopsych.2019.11.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heterogeneity in autism spectrum disorder (ASD) has hindered the development of biomarkers, thus motivating subtyping efforts. Most subtyping studies divide individuals with ASD into nonoverlapping (categorical) subgroups. However, continuous interindividual variation in ASD suggests that there is a need for a dimensional approach. METHODS A Bayesian model was employed to decompose resting-state functional connectivity (RSFC) of individuals with ASD into multiple abnormal RSFC patterns, i.e., categorical subtypes, henceforth referred to as "factors." Importantly, the model allowed each individual to express one or more factors to varying degrees (dimensional subtyping). The model was applied to 306 individuals with ASD (5.2-57 years of age) from two multisite repositories. Post hoc analyses associated factors with symptoms and demographics. RESULTS Analyses yielded three factors with dissociable whole-brain hypo- and hyper-RSFC patterns. Most participants expressed multiple (categorical) factors, suggestive of a mosaic of subtypes within individuals. All factors shared abnormal RSFC involving the default mode network, but the directionality (hypo- or hyper-RSFC) differed across factors. Factor 1 was associated with core ASD symptoms. Factors 1 and 2 were associated with distinct comorbid symptoms. Older male participants preferentially expressed factor 3. Factors were robust across control analyses and were not associated with IQ or head motion. CONCLUSIONS There exist at least three ASD factors with dissociable whole-brain RSFC patterns, behaviors, and demographics. Heterogeneous default mode network hypo- and hyper-RSFC across the factors might explain previously reported inconsistencies. The factors differentiated between core ASD and comorbid symptoms-a less appreciated domain of heterogeneity in ASD. These factors are coexpressed in individuals with ASD with different degrees, thus reconciling categorical and dimensional perspectives of ASD heterogeneity.
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Affiliation(s)
- Siyi Tang
- Department of Electrical and Computer Engineering, Centre for Sleep and Cognition, Clinical Imaging Research Centre, N.1 Institute for Health, National University of Singapore, Singapore, Republic of Singapore; Department of Electrical Engineering, Stanford University, Stanford, California
| | - Nanbo Sun
- Department of Electrical and Computer Engineering, Centre for Sleep and Cognition, Clinical Imaging Research Centre, N.1 Institute for Health, National University of Singapore, Singapore, Republic of Singapore
| | - Dorothea L Floris
- Donders Center for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands; Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Xiuming Zhang
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Adriana Di Martino
- Autism and Social Cognition Center, Child Mind Institute, New York, New York
| | - B T Thomas Yeo
- Department of Electrical and Computer Engineering, Centre for Sleep and Cognition, Clinical Imaging Research Centre, N.1 Institute for Health, National University of Singapore, Singapore, Republic of Singapore; Centre for Cognitive Neuroscience, Duke-National University of Singapore Medical School, Singapore, Republic of Singapore; National University of Singapore Graduate School for Integrative Sciences and Engineering, Singapore, Republic of Singapore; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.
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23
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Anderson KA, Hemmeter J, Rast JE, Roux AM, Shattuck PT. Trends in Supplemental Security Income Payments to Adults With Autism. Psychiatr Serv 2020; 71:602-607. [PMID: 32264799 DOI: 10.1176/appi.ps.201900265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study used Social Security Administration program data to identify population-level trends in Supplemental Security Income (SSI) program participation and payments to adult recipients with autism spectrum disorder (ASD) relative to recipients with intellectual disability and other mental disorders. METHODS The authors examined SSI program data from 2005 to 2015. Variables included caseload size, number of new adult awardees per year, total annual SSI payments per disability group, and average annual SSI payment per recipient. RESULTS Adults with ASD represented a growing share of the total first-time SSI awards given to adults with mental disorders, with percentages increasing from 1.3% in 2005 to 5.0% in 2015. In 2015, 158,105 adults with ASD received SSI benefits, a 326.8% increase since 2005. Federal SSI payments to adults with ASD increased by 383.2% during the same period (totaling roughly $1.0 billion in 2015). The annual average payment for adults with ASD was $6,527.40 in 2015. CONCLUSIONS The purpose of the SSI program is to reduce the extent of poverty by providing monthly payments to eligible individuals with disabilities. The authors found that a large and growing number of adults with autism receive SSI benefits. This finding underscores the importance of future research related to the economic security of adults on the autism spectrum.
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Affiliation(s)
- Kristy A Anderson
- A. J. Drexel Autism Institute, Drexel University, Philadelphia (Anderson, Rast, Roux, Shattuck); Office of Research, Demonstration, and Employment Support, Social Security Administration, Baltimore (Hemmeter)
| | - Jeffrey Hemmeter
- A. J. Drexel Autism Institute, Drexel University, Philadelphia (Anderson, Rast, Roux, Shattuck); Office of Research, Demonstration, and Employment Support, Social Security Administration, Baltimore (Hemmeter)
| | - Jessica E Rast
- A. J. Drexel Autism Institute, Drexel University, Philadelphia (Anderson, Rast, Roux, Shattuck); Office of Research, Demonstration, and Employment Support, Social Security Administration, Baltimore (Hemmeter)
| | - Anne M Roux
- A. J. Drexel Autism Institute, Drexel University, Philadelphia (Anderson, Rast, Roux, Shattuck); Office of Research, Demonstration, and Employment Support, Social Security Administration, Baltimore (Hemmeter)
| | - Paul T Shattuck
- A. J. Drexel Autism Institute, Drexel University, Philadelphia (Anderson, Rast, Roux, Shattuck); Office of Research, Demonstration, and Employment Support, Social Security Administration, Baltimore (Hemmeter)
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24
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Parr JR, Brice S, Welsh P, Ingham B, Le Couteur A, Evans G, Monaco A, Freeston M, Rodgers J. Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment-Autism (PAT-A©) pilot randomised controlled feasibility trial. Trials 2020; 21:265. [PMID: 32171316 PMCID: PMC7071661 DOI: 10.1186/s13063-020-4161-2] [Citation(s) in RCA: 10] [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] [Received: 10/15/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. METHODS/DESIGN This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. DISCUSSION This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people. TRIAL REGISTRATION ISRCTN, ID: 15881562. Retrospectively registered on 9 August 2019.
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Affiliation(s)
- Jeremy R. Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Welsh
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Evans
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander Monaco
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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25
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Man J, Kangas M. Best Practice Principles When Working With Individuals With Intellectual Disability and Comorbid Mental Health Concerns. QUALITATIVE HEALTH RESEARCH 2020; 30:560-571. [PMID: 31328633 DOI: 10.1177/1049732319858326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Working with individuals with dual disabilities can be a complex process in the presence of limited evidence base to guide clinical practice. The aims of this qualitative study were to investigate perceptions of best practices of Australian psychologists who work with this specialist population. Thirty-eight Australian psychologists working in the intellectual disability field participated in eight semistructured focus groups. Perceptions of evidence-based practice for individuals with intellectual disabilities and in relation to mental health assessment were explored. Psychologists demonstrated resourcefulness in adapting to limits in available evidence-based practice and in modifying mainstream practice to suit the needs of individuals with dual disabilities. Findings suggest the necessity of practice-based evidence in contributing to the evidence base, and person-centered approaches in relation to best practice for people with intellectual disabilities. Implications for strengthening psychologists' clinical competency and bridging the research and practice gap are discussed.
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Affiliation(s)
- Joyce Man
- Centre for Emotiona Health, Macquarie University, Sydney, New South Wales, Australia
- University of Cambridge, Cambridge, United Kingdom
| | - Maria Kangas
- Centre for Emotiona Health, Macquarie University, Sydney, New South Wales, Australia
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26
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Frigaux A, Evrard R, Lighezzolo-Alnot J. L’intérêt du test de Rorschach dans l’évaluation diagnostique des troubles du spectre autistique. EVOLUTION PSYCHIATRIQUE 2020. [DOI: 10.1016/j.evopsy.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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O’Connor C, Downs J, Shetty H, McNicholas F. Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register. Eur Child Adolesc Psychiatry 2020; 29:1111-1123. [PMID: 31679098 PMCID: PMC7369254 DOI: 10.1007/s00787-019-01428-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/22/2019] [Indexed: 12/03/2022]
Abstract
Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days' distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients' likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.
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Affiliation(s)
- Cliodhna O’Connor
- grid.7886.10000 0001 0768 2743School of Psychology, University College Dublin, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Johnny Downs
- grid.37640.360000 0000 9439 0839NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- grid.37640.360000 0000 9439 0839NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona McNicholas
- grid.7886.10000 0001 0768 2743School of Medicine and Medical Science, University College Dublin, Dublin, Ireland ,St John of God Hospitaller Services, Dublin, Ireland ,grid.417322.10000 0004 0516 3853Our Lady’s Hospital for Sick Children, Crumlin, Ireland
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28
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Rodriguez-Seijas C, Gadow KD, Rosen TE, Kim H, Lerner MD, Eaton NR. A transdiagnostic model of psychiatric symptom co-occurrence and autism spectrum disorder. Autism Res 2019; 13:579-590. [PMID: 31647197 DOI: 10.1002/aur.2228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022]
Abstract
Understanding whether the co-occurrence of psychiatric symptoms within autism spectrum disorder (ASD) are specific to the ASD diagnosis or reflect similar higher-order patterns observed in both ASD and non-ASD samples, or a confluence of the two, is of critical importance. If similar, it would suggest that comorbid psychiatric conditions among individuals with ASD are not symptoms of specific, non-ASD psychiatric disorders per se, but reflect a general liability to psychopathology associated with ASD. To this end, the current study examined whether the higher-order structure of co-occurring psychiatric symptoms was the same within ASD and non-ASD youth. Parents of clinic-referred youth with (n = 280) and without (n = 943) ASD completed a DSM-IV-referenced psychiatric symptom rating scale. A confirmatory factor analytic framework was used to examine four levels of measurement invariance across groups to determine the extent to which transdiagnostic factors were comparable. Transdiagnostic factors were characterized by symptoms of the same disorders (configural invariance) and the same factor loadings across groups (metric invariance). Furthermore, both groups evidenced equivalent numbers of symptoms of most psychiatric conditions with the notable exceptions of attention deficit hyperactivity disorder (ADHD) and social anxiety (partial strong invariance), which were higher in the ASD sample. It was concluded that disparities in the co-occurrence of psychiatric symptoms between youth with and without ASD may be largely reflective of transdiagnostic factor level differences associated with ASD and not indicative of the ASD diagnosis per se. However, for ADHD and social anxiety, there appears to be some specific associations with the ASD diagnosis. Autism Res 2020, 13: 579-590. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Few transdiagnostic dimensions relate common mental disorder diagnoses with one another. These dimensions explain psychiatric comorbidity (i.e., the finding that many persons possess several disorder diagnoses simultaneously). However, it is unclear if these dimensions differ among children with autism spectrum disorder (ASD), compared with their non-ASD counterparts. The results of this study demonstrate that underlying transdiagnostic dimensions are similar in both ASD and non-ASD children. However, there appear to be ASD-specific differences when it comes to social anxiety and attention deficit hyperactivity disorder.
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Affiliation(s)
| | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Tamara E Rosen
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Hyunsik Kim
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York
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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: 2.0] [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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LaFrance DL, Weiss MJ, Kazemi E, Gerenser J, Dobres J. Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding. Behav Anal Pract 2019; 12:709-726. [PMID: 31976281 PMCID: PMC6743510 DOI: 10.1007/s40617-019-00331-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In an effort to provide clarity about the unique contributions of several professions within the context of multidisciplinary treatment, we reviewed the definitions, philosophical underpinnings, and national requirements pertaining to both scopes of practice (i.e., model licensing acts, legislation, and regulatory boards) and training (i.e., task lists, accreditation standards and course requirements, and exam blueprints) of 4 behavioral health professions. The professions we selected (behavior analysis, psychology, speech-language pathology, and occupational therapy) are likely to provide treatment alongside one another and often to the same clients. In a review of documents pertaining to scopes of practice and training for each profession, we found overlapping content. However, the similarities between professions diminished when we reviewed more specific guidelines such as learning objectives, educational requirements (i.e., coursework), supervised clinical experience (e.g., internships), and national examinations. This was especially true when considering each profession's underlying approach to treatment (i.e., philosophical underpinnings) and, hence, service activities. We discuss our findings in light of service overlap and make a call for greater collaboration between professions, as related to the separate content knowledge and expertise of professionals in each field and the impact on client outcomes.
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Affiliation(s)
- Danielle L. LaFrance
- H.O.P.E. Consulting, 7949 California Avenue, Fair Oaks, CA 95628-7101 USA
- ABA/Autism Studies Program, Endicott College, Beverly, MA USA
| | - Mary Jane Weiss
- ABA/Autism Studies Program, Endicott College, Beverly, MA USA
| | | | | | - Jacqueline Dobres
- Douglass Developmental Disabilities Center, Rutgers University, New Brunswick, NJ USA
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Treatment-resistant depression: consider autism. Br J Gen Pract 2019; 69:14. [DOI: 10.3399/bjgp19x700373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Au-Yeung SK, Bradley L, Robertson AE, Shaw R, Baron-Cohen S, Cassidy S. Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1508-1518. [DOI: 10.1177/1362361318818167] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous research shows that autistic people have high levels of co-occurring mental health conditions. Yet, a number of case reports have revealed that mental health conditions are often misdiagnosed in autistic individuals. A total of 420 adults who identified as autistic, possibly autistic or non-autistic completed an online survey consisting of questions regarding mental health diagnoses they received, whether they agreed with those diagnoses and if not why. Autistic and possibly autistic participants were more likely to report receiving mental health diagnoses compared to non-autistic participants, but were less likely to agree with those diagnoses. Thematic analysis revealed the participants’ main reasons for disagreement were that (1) they felt their autism characteristics were being confused with mental health conditions by healthcare professionals and (2) they perceived their own mental health difficulties to be resultant of ASC. Participants attributed these to the clinical barriers they experienced, including healthcare professionals’ lack of autism awareness and lack of communication, which in turn prevented them from receiving appropriate support. This study highlights the need for autism awareness training for healthcare professionals and the need to develop tools and interventions to accurately diagnose and effectively treat mental health conditions in autistic individuals.
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Affiliation(s)
| | | | | | - Rebecca Shaw
- Coventry University, UK
- Coventry and Warwickshire Partnership NHS Trust, UK
| | - Simon Baron-Cohen
- University of Cambridge, UK
- Cambridge Lifespan Asperger Syndrome Service (CLASS), UK
| | - Sarah Cassidy
- Coventry University, UK
- University of Cambridge, UK
- University of Nottingham, UK
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Alresheed F, Machalicek W, Sanford A, Bano C. Academic and Related Skills Interventions for Autism: a 20-Year Systematic Review of Single-Case Research. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0141-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Prosperi M, Santocchi E, Balboni G, Narzisi A, Bozza M, Fulceri F, Apicella F, Igliozzi R, Cosenza A, Tancredi R, Calderoni S, Muratori F. Behavioral Phenotype of ASD Preschoolers with Gastrointestinal Symptoms or Food Selectivity. J Autism Dev Disord 2018; 47:3574-3588. [PMID: 28861653 DOI: 10.1007/s10803-017-3271-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the prevalence and type of gastrointestinal (GI) and food selectivity (FS) symptoms in 163 preschoolers with ASD, and their possible links with core ASD features and emotional/behavioural problems. 40.5% of children with ASD had at least one severe GI symptom or FS. Preschoolers with and without GI symptoms and with and without FS were significantly different on several emotional/behavioural problems and restrictive/repetitive behaviours, whereas they did not differ significantly on performance IQ and autistic severity. The GI plus FS group presented with Sleep Problems, Self-injurious Behaviors and Anxiety Problems. Results indicated the need for early identification of GI disturbances and FS in order to design tailored intervention for these symptoms frequently associated to challenging behaviours in ASD.
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Affiliation(s)
- Margherita Prosperi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Elisa Santocchi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Giulia Balboni
- University of Perugia, Piazza G. Ermini, 1, 06123, Perugia, Italy
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | | | - Francesca Fulceri
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Fabio Apicella
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Roberta Igliozzi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Angela Cosenza
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Raffaella Tancredi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Sara Calderoni
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Sim A, Vaz S, Cordier R, Joosten A, Parsons D, Smith C, Falkmer T. Factors associated with stress in families of children with autism spectrum disorder. Dev Neurorehabil 2018; 21:155-165. [PMID: 28598245 DOI: 10.1080/17518423.2017.1326185] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD). METHODS Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression. RESULTS Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress. CONCLUSION The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.
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Affiliation(s)
- Angela Sim
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Sharmila Vaz
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Reinie Cordier
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Annette Joosten
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Dave Parsons
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Cally Smith
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia
| | - Torbjörn Falkmer
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Western Australia , Australia.,b School of Occupational Therapy , La Trobe University , Melbourne , Vic , Australia.,c Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH) , Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council , Linköping , Sweden.,d Cooperative Research Centre for Living with Autism Spectrum Disorders (Autism CRC), Long Pocket , Brisbane , Queensland , Australia
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Abstract
OBJECTIVES Clinical neuroscience is increasingly turning to imaging the human brain for answers to a range of questions and challenges. To date, the majority of studies have focused on the neural basis of current psychiatric symptoms, which can facilitate the identification of neurobiological markers for diagnosis. However, the increasing availability and feasibility of using imaging modalities, such as diffusion imaging and resting-state fMRI, enable longitudinal mapping of brain development. This shift in the field is opening the possibility of identifying predictive markers of risk or prognosis, and also represents a critical missing element for efforts to promote personalized or individualized medicine in psychiatry (i.e., stratified psychiatry). METHODS The present work provides a selective review of potentially high-yield populations for longitudinal examination with MRI, based upon our understanding of risk from epidemiologic studies and initial MRI findings. RESULTS Our discussion is organized into three topic areas: (1) practical considerations for establishing temporal precedence in psychiatric research; (2) readiness of the field for conducting longitudinal MRI, particularly for neurodevelopmental questions; and (3) illustrations of high-yield populations and time windows for examination that can be used to rapidly generate meaningful and useful data. Particular emphasis is placed on the implementation of time-appropriate, developmentally informed longitudinal designs, capable of facilitating the identification of biomarkers predictive of risk and prognosis. CONCLUSIONS Strategic longitudinal examination of the brain at-risk has the potential to bring the concepts of early intervention and prevention to psychiatry.
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Paul LK, Corsello C, Kennedy DP, Adolphs R. Agenesis of the corpus callosum and autism: a comprehensive comparison. ACTA ACUST UNITED AC 2014; 137:1813-29. [PMID: 24771497 DOI: 10.1093/brain/awu070] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The corpus callosum, with its ∼200 million axons, remains enigmatic in its contribution to cognition and behaviour. Agenesis of the corpus callosum is a congenital condition in which the corpus callosum fails to develop; such individuals exhibit localized deficits in non-literal language comprehension, humour, theory of mind and social reasoning. These findings together with parent reports suggest that behavioural and cognitive impairments in subjects with callosal agenesis may overlap with the profile of autism spectrum disorders, particularly with respect to impairments in social interaction and communication. To provide a comprehensive test of this hypothesis, we directly compared a group of 26 adults with callosal agenesis to a group of 28 adults with a diagnosis of autism spectrum disorder but no neurological abnormality. All participants had full-scale intelligence quotient scores >78 and groups were matched on age, handedness, and gender ratio. Using the Autism Diagnostic Observation Schedule together with current clinical presentation to assess autistic symptomatology, we found that 8/26 (about a third) of agenesis subjects presented with autism. However, more formal diagnosis additionally involving recollective parent-report measures regarding childhood behaviour showed that only 3/22 met complete formal criteria for an autism spectrum disorder (parent reports were unavailable for four subjects). We found no relationship between intelligence quotient and autism symptomatology in callosal agenesis, nor evidence that the presence of any residual corpus callosum differentiated those who exhibited current autism spectrum symptoms from those who did not. Relative to the autism spectrum comparison group, parent ratings of childhood behaviour indicated children with agenesis were less likely to meet diagnostic criteria for autism, even for those who met autism spectrum criteria as adults, and even though there was no group difference in parent report of current behaviours. The findings suggest two broad conclusions. First, they support the hypothesis that congenital disruption of the corpus callosum constitutes a major risk factor for developing autism. Second, they quantify specific features that distinguish autistic behaviour associated with callosal agenesis from autism more generally. Taken together, these two findings also leverage specific questions for future investigation: what are the distal causes (genetic and environmental) determining both callosal agenesis and its autistic features, and what are the proximal mechanisms by which absence of the callosum might generate autistic symptomatology?
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Affiliation(s)
- Lynn K Paul
- 1 California Institute of Technology, Division of Humanities and Social Sciences, Pasadena, CA, USA
| | | | - Daniel P Kennedy
- 1 California Institute of Technology, Division of Humanities and Social Sciences, Pasadena, CA, USA3 Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Ralph Adolphs
- 1 California Institute of Technology, Division of Humanities and Social Sciences, Pasadena, CA, USA4 California Institute of Technology, Division of Biology, California Institute of Technology, Pasadena, CA, USA
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