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Low HM, Zainal MS, Pang JC, Ang Y, de Vries M. Self-reported autistic traits and psychosocial outcomes among university students in Malaysia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:174-186. [PMID: 37128140 DOI: 10.1177/13623613231167501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
LAY ABSTRACT Most research on autism spectrum conditions is done on young children and not as much on young adults with autism spectrum conditions. Because of this, not much is known about how common autism spectrum conditions are in young adults and how they affect their mental and social health, especially in Southeast Asia. Based on self-reports, 2.8% of the 2732 university students we looked at in Malaysia might have been diagnosed or thought to have an autism spectrum condition. Students who said they had or thought they had autism spectrum conditions had lower self-efficacy, more stress and a lower quality of life than students who said they did not have autism spectrum conditions. The results showed that university students with autism spectrum condition are more likely to have bad psychological and social outcomes than their peers without autism spectrum condition. Also, the link between autistic traits and psychosocial outcomes could depend on the culture.
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Rivera RA, Bennetto L. Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Front Psychiatry 2023; 14:1243657. [PMID: 37743980 PMCID: PMC10511883 DOI: 10.3389/fpsyt.2023.1243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.
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Affiliation(s)
- Rachel A. Rivera
- Department of Psychology, University of Rochester, Rochester, NY, United States
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3
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Ghanouni P, Seaker L. What does receiving autism diagnosis in adulthood look like? Stakeholders' experiences and inputs. Int J Ment Health Syst 2023; 17:16. [PMID: 37291614 DOI: 10.1186/s13033-023-00587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. METHOD We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. RESULTS Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. CONCLUSION This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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Bach B, Vestergaard M. Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:992. [PMID: 37371224 DOI: 10.3390/children10060992] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has pointed out that, in some cases, adolescents with autism spectrum disorder are at risk of being confused with having a personality disorder, which particularly applies to female adolescents. Case reports describe how adult autistic women struggled with social and identity roles as children and adolescents, using compensatory strategies such as social imitation and other types of camouflaging. Furthermore, some adolescents with autism display emotion dysregulation and self-injury. The ICD-11 recognizes that features of autism spectrum disorder may resemble features of personality disorder, but the two diagnoses have not yet been formally compared to one another. The present article therefore sought to outline and discuss the overlap and boundaries between the ICD-11 definitions of personality disorder and autism spectrum disorder and propose guiding principles that may assist practitioners in differential diagnosis with female adolescents. We specifically highlight how aspects of the self and interpersonal functioning along with emotional, cognitive, and behavioral manifestations may overlap across the two diagnoses. Restricted, repetitive, and inflexible patterns of behavior, interests, and activities are core features of autism spectrum disorder, which may be masked or less pronounced in female adolescents. Collecting a developmental history of the early presence or absence of autistic features is vital for a conclusive diagnosis, including features that are typically camouflaged in females. A number of future directions for research and clinical practice are proposed.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | - Martin Vestergaard
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Child and Adolescence Psychiatry (Copenhagen University Hospital), Mental Health Services, Region Zealand, 4000 Roskilde, Denmark
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5
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Walsh D, Brooks G, Naka M, Oxburgh G, Kyo A. Forensic interviews conducted with autistic adults in Japan: a review of the literature and directions for future research. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:216-234. [PMID: 38628248 PMCID: PMC11018090 DOI: 10.1080/13218719.2023.2192255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/22/2023] [Indexed: 04/19/2024]
Abstract
The interviewing of victims, witnesses and suspects is important in helping resolve criminal investigations. In Japan, developments have recently occurred in the training of the police and their public prosecutors in these key tasks. Whilst literature exists on autism in Japan, studies examining police/public prosecutor interviews with autistic adults conducted in that country (and indeed, any other) remain scant. As elsewhere in the world, identification of those who manifest characteristics prevalent on the autism spectrum disorder (ASD) scale, has been found to be problematical to criminal justice professionals. To help address this deficit in understanding, we provide an overview of the literature concerning contemporary understanding of the challenges facing autistic adults as they attempt to reveal their verbal accounts, as well as suggested techniques when interviewing adults on the ASD scale during criminal investigations, offering lessons learned from research conducted around the world that provide potentially promising solutions for Japan.
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Affiliation(s)
- Dave Walsh
- School of Law, De Montfort University, Leicester, UK
| | - Graham Brooks
- School of Human and Social Sciences, University of West London, London, UK
| | - Makiko Naka
- Department of Psychology, Ritsumeikin University, Osaka, Japan
| | - Gavin Oxburgh
- Department of Social Sciences, Northumbria University, UK
| | - Akira Kyo
- Department of Law, Kwansei Gakuin University, Nishinomiya, Japan
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6
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Schaeffer J, Abd El-Raziq M, Castroviejo E, Durrleman S, Ferré S, Grama I, Hendriks P, Kissine M, Manenti M, Marinis T, Meir N, Novogrodsky R, Perovic A, Panzeri F, Silleresi S, Sukenik N, Vicente A, Zebib R, Prévost P, Tuller L. Language in autism: domains, profiles and co-occurring conditions. J Neural Transm (Vienna) 2023; 130:433-457. [PMID: 36922431 PMCID: PMC10033486 DOI: 10.1007/s00702-023-02592-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/14/2023] [Indexed: 03/18/2023]
Abstract
This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.
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Affiliation(s)
- Jeannette Schaeffer
- Department of Literary and Cultural Analysis & Linguistics, Faculty of Humanities, University of Amsterdam, PO Box 1642, 1000 BP, Amsterdam, The Netherlands.
| | | | | | | | - Sandrine Ferré
- UMR 1253 iBrain, Université de Tours, INSERM, Tours, France
| | - Ileana Grama
- Department of Literary and Cultural Analysis & Linguistics, Faculty of Humanities, University of Amsterdam, PO Box 1642, 1000 BP, Amsterdam, The Netherlands
| | | | | | - Marta Manenti
- UMR 1253 iBrain, Université de Tours, INSERM, Tours, France
| | | | | | | | | | | | | | | | - Agustín Vicente
- University of the Basque Country, Vitoria-Gasteiz, Spain
- Basque Foundation for Science, Ikerbasque, Bilbao, Spain
| | - Racha Zebib
- UMR 1253 iBrain, Université de Tours, INSERM, Tours, France
| | | | - Laurice Tuller
- UMR 1253 iBrain, Université de Tours, INSERM, Tours, France
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7
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Perinelli MG, Cloherty M. Identification of autism in cognitively able adults with epilepsy: A narrative review and discussion of available screening and diagnostic tools. Seizure 2023; 104:6-11. [PMID: 36442428 DOI: 10.1016/j.seizure.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
The recent NICE epilepsy Guideline (NG217; 2022) recommends that epilepsy professionals need to be alert to autism when considering mental health presentations, behavioural difficulties and as a marker for referral for whole genome sequencing for those patients with epilepsy of unknown cause. However, this relies upon the existence of valid autism screens for people with epilepsy (PWE). We found few studies of autism in cognitively able PWE. This represents an important gap in the literature. We describe different autism screening and diagnostic tools; two screening tools have been used specifically for adult PWE who are cognitively able (AQ, SRS-AS). The AQ is more psychometrically robust, but there may be an overlap between these screening questions and questions relevant to some psychiatric disorders. Formal gold-standard diagnostic tools (module 4 of ADOS-2, ADI-R or 3Di or 3Di-Adult) would benefit from studies of their application to cognitively able PWE. More research is needed to understand the characteristics of autism in cognitively able PWE and to ascertain the appropriate screening and diagnostic tools for this cohort.
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Affiliation(s)
- Martina Giorgia Perinelli
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom
| | - Monique Cloherty
- Epilepsy Centre, Clinical Neurosciences Department, Kings College Hospital, 4th Floor Ruskin Wing, Denmark Hill, London SE5 9RS, United Kingdom.
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‘I was never broken—I just don’t fit in this world.’ A case report series of misdiagnosed women with higher functioning ASD. Nord J Psychiatry 2022; 77:352-359. [PMID: 37127053 DOI: 10.1080/08039488.2022.2112973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Differentiating between autism spectrum disorders (ASD) and borderline personality disorder (BPD) is hampered by diagnostic difficulties as there seems to be a significant overlap in symptoms. METHODS A case series of six women with ASD and a previous diagnosis of BPD is presented. RESULTS In retrospect, the women did not present with significant symptoms until they had developed comorbidity, which clinicians in turn misinterpreted. The missed diagnosis or misdiagnosis had significant implications for their prognosis and current level of functioning. This suggests in line with previous research, that women with higher functioning ASD are more at risk of being overlooked. CONCLUSION It is suggested in the literature and supported by this case series that ASD should be ruled out by obtaining a thorough developmental history by an experienced clinician before considering a BPD diagnosis.
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Sofologi M, Pliogou V, Bonti E, Efstratopoulou M, Kougioumtzis GA, Papatzikis E, Ntritsos G, Moraitou D, Papantoniou G. An Investigation of Working Memory Profile and Fluid Intelligence in Children With Neurodevelopmental Difficulties. Front Psychol 2022; 12:773732. [PMID: 35370868 PMCID: PMC8973915 DOI: 10.3389/fpsyg.2021.773732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
The present study aims to evaluate the distinct patterns of working memory (WM) capacity of children with Developmental Language Disorder (DLD), High-functioning children with Autism Spectrum Disorder (ASD) and children with Down syndrome (DS). More specifically, the current study investigates the complex relationship of fluid intelligence and WM between 39 children with DLD, 20 H igh-functioning children with ASD, and 15 children with DS. All children were evaluated in different measures of Phonological Working Memory, Visual-spatial Working Memory whereas Fluid Intelligence was measured with Raven Progressive Matrices. The result analysis revealed a significant difference among the three groups, both among each function separately and the correlations among them, as well. The results revealed that the DLD groups and High-functioning ASD group exhibited a common picture or an overlap of performances in all Phonological and Visuo-spatial working memory measures, except Backward Digit Recall task. As for the DS group research findings revealed different and unique working memory patterns in comparison to DLD group and High-functioning ASD. Their differences have been studied and further conclusions have been drawn about the different patterns of working memory among the three clinical groups. The implications of these findings are discussed in light of support for learning. The common profile that characterize the two developmental conditions and the distinct pattern of working memory performance in DS group underlies the need for further research in the field.
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Affiliation(s)
- Maria Sofologi
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, Ioannina, Greece
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina (URCI), Ioannina, Greece
| | - Vassiliki Pliogou
- Department of Early Childhood Education, School of Humanities and Social Sciences, University of Western Macedonia, Florina, Greece
| | - Eleni Bonti
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Education, School of Education, University of Nicosia, Nicosia, Cyprus
- Department of Special Education (CEDU), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Maria Efstratopoulou
- Department of Special Education (CEDU), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Georgios A. Kougioumtzis
- Department of Turkish and Modern Asian Studies, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymios Papatzikis
- Department of Early Childhood Education and Care, Oslo Metropolitan University, Oslo, Norway
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Arta, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Section of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Papantoniou
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, Ioannina, Greece
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina (URCI), Ioannina, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Wigham S, Ingham B, Le Couteur A, Wilson C, Ensum I, Parr JR. A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1959-1972. [PMID: 35168407 PMCID: PMC9597166 DOI: 10.1177/13623613211073020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accessing adult autism diagnostic pathways can be difficult. This study explored
perspectives of UK autistic adults, relatives and clinicians regarding the
characteristics of optimal adult autism assessment and diagnostic services. In
stage 1, three key stakeholder groups were surveyed about experiences of adult
autism diagnostic services (pre-assessment/assessment): 343 autistic adults, 45
relatives and 35 clinicians completed parallel surveys. Information from stage 1
surveys was used to devise statements for a modified Delphi process in stage 2
seeking consensus among clinicians on optimal diagnostic service
characteristics. Data analyses were non-parametric and descriptive. Over half of
adults were in contact with mental health services prior to autism diagnosis.
Clinicians reported that multidisciplinary diagnostic teams lacked key
professionals. Thirteen statements describing optimal autism diagnostic service
provision were developed. There was consensus from clinicians on 11 statements
relating to clear assessment pathways, updates for people while waiting,
pre-assessment information gathering/provision, co-occurring condition
identification and training/networking. Some autistic adults, relatives and
clinicians were positive about services, all stakeholders identified
improvements were needed. The findings describing optimal service provision are
relevant for UK clinicians, managers and commissioners to improve diagnostic
assessments for autistic adults, and have international relevance for similar
health systems.
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Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute, Newcastle University, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, UK
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
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11
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Understanding Camouflaging as a Response to Autism-Related Stigma: A Social Identity Theory Approach. J Autism Dev Disord 2021; 52:800-810. [PMID: 33788076 PMCID: PMC8813820 DOI: 10.1007/s10803-021-04987-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
Camouflaging refers to strategies used by autistic people to mask or hide social difficulties. The current study draws on Social Identity Theory to examine the relationship between camouflaging and autism-related stigma, testing the hypothesis that camouflaging represents an individualistic strategy in response to stigma. Two hundred and twenty-three autistic adults completed an online survey measuring perceived autism-related stigma, individualistic and collective strategies, camouflaging and mental wellbeing. Results indicated that higher camouflaging was positively associated with autism-related stigma and both individualistic and collective strategy use. Autism-related stigma was associated with lower wellbeing however this relationship was not mediated by camouflaging. These findings demonstrate how stigma contributes to camouflaging and highlight the complexities of navigating autistic identity while still camouflaging.
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12
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Evers K, Maljaars J, Carrington SJ, Carter AS, Happé F, Steyaert J, Leekam SR, Noens I. How well are DSM-5 diagnostic criteria for ASD represented in standardized diagnostic instruments? Eur Child Adolesc Psychiatry 2021; 30:75-87. [PMID: 32076870 DOI: 10.1007/s00787-020-01481-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/23/2020] [Indexed: 01/19/2023]
Abstract
Five years after the publication of DSM-5 in 2013, three widely used diagnostic instruments have published algorithms designed to represent its (sub-)criteria for Autism Spectrum Disorder (ASD) in children and adolescents. This study aimed to: (1) establish the content validity of these three DSM-5-adapted algorithms, and (2) identify problems with the operationalization of DSM-5 diagnostic criteria in measurable and observable behaviors. Algorithm items of the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3di) and Diagnostic Interview for Social and Communication Disorders-11th edition (DISCO-11) were mapped onto DSM-5 sub-criteria. The development and decision-making rules integrated in their algorithms were then compared with DSM-5. Results demonstrated significant variability in the number and nature of sub-criteria covered by the ADOS-2, 3di and DISCO-11. In addition to differences in the development of algorithms and cut-off scores, instruments also differed in the extent to which they follow DSM-5 decision-making rules for diagnostic classification. We conclude that such differences in interpretation of DSM-5 criteria provide a challenge for symptom operationalization which will be most effectively overcome by consensus, testing and reformulation.
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Affiliation(s)
- Kris Evers
- Parenting and Special Education Research Unit, KU Leuven, Leopold Vanderkelenstraat 32, P.O. Box 3765, 3000, Leuven, Belgium. .,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium. .,Child and Adolescent Psychiatry, Z.org UPC KU Leuven, Leuven, Belgium.
| | - Jarymke Maljaars
- Parenting and Special Education Research Unit, KU Leuven, Leopold Vanderkelenstraat 32, P.O. Box 3765, 3000, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Child and Adolescent Psychiatry, Z.org UPC KU Leuven, Leuven, Belgium
| | - Sarah J Carrington
- School of Life and Health Sciences, Department of Psychology, Aston University, Birmingham, UK
| | | | - Francesca Happé
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Child and Adolescent Psychiatry, Z.org UPC KU Leuven, Leuven, Belgium.,Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Ilse Noens
- Parenting and Special Education Research Unit, KU Leuven, Leopold Vanderkelenstraat 32, P.O. Box 3765, 3000, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
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13
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Wigham S, Ingham B, Le Couteur A, Berney T, Ensum I, Parr JR. Development and Initial Utility of the Autism Clinical Interview for Adults: A New Adult Autism Diagnostic Measure. AUTISM IN ADULTHOOD 2020; 2:42-47. [PMID: 36600980 PMCID: PMC8992846 DOI: 10.1089/aut.2019.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Clinicians use diagnostic interviews to help them gather and organize information collected in the assessment of autism. Most instruments are developed for children and few measures have been developed that are reliable, valid, and appropriate for use in adulthood. This is a significant barrier to providing a high-quality, timely service for adults. The aim of this development study was to assess the initial utility of the recently developed Autism Clinical Interview for Adults (ACIA) for use in autism diagnostic clinical services before further large-scale testing and evaluation. Methods We invited adults who had received an autism spectrum diagnosis through a U.K. National Health Service (NHS) multidisciplinary adult autism assessment to participate. Seventeen autistic adults (8 women and 9 men, mean age of 37 years) and four relatives agreed to an interview. The semistructured ACIA interview comprises subject and informant versions, and a self-report preinterview questionnaire. In combination, the ACIA components cover topics relevant to autism and co-occurring condition assessment. We evaluated clinical utility and content validity via comparison with the Diagnostic and Statistical Manual Fifth Edition (DSM-5) and NHS diagnostic reports. Results Each interview took between 60 and 90 minutes to complete. Comparison with DSM-5 and the NHS autism diagnostic report demonstrated that the ACIA accurately identified information on core autism characteristics needed for a diagnosis, and identified co-occurring conditions. In response to participant suggestions we revised the interview. Conclusions These initial findings support the potential utility and validity of the ACIA for adult autism diagnostic clinical services. Further investigations of the acceptability, utility, and validity of this interview are planned. Lay summary Why was this study done?: Clinicians use diagnostic interviews during assessments to help gather and record information both from a person suspected to be on the autism spectrum and from an informant (someone who knows them well). However, most autism diagnostic interviews were originally developed for assessing autism in childhood, and few have been developed for use with adults. The lack of diagnostic interviews developed specifically for use with adults makes it difficult to provide a good-quality, consistent assessment.What was the purpose of this study?: The study tested a new semistructured diagnostic interview called the Autism Clinical Interview for Adults (ACIA). The ACIA includes a questionnaire for people to complete before their interview. This is followed by an interview that can be conducted with the person themselves and a separate version to be used with someone who knows them well (if permitted). The interview covers autism traits, strengths and difficulties, and co-occurring physical and mental health conditions. We wanted to find out if the interview is useful for autism diagnostic services by comparing information collected using the ACIA with clinical diagnostic reports.What did the researchers do?: We invited people who had received a diagnosis of autism from a U.K. National Health Service (NHS) assessment to take part in an interview. We asked them if we could also interview someone who knew them well, and if we could compare their NHS autism diagnostic report with information gathered using the ACIA.What were the results of the study?: Seventeen autistic adults (average age 37 years; 8 women and 9 men) and 4 relatives/supporters (2 parents, a spouse, and a cohabiting partner) agreed to be interviewed. Each interview took 60 to 90 minutes to complete. A comparison with clinical reports showed the ACIA identified autism traits relevant for a diagnosis, as well as co-occurring conditions (e.g., depression). Participants suggested some ways to improve the interview, and revisions were made.What do these findings add to what is already known?: There are few diagnostic interviews designed specifically for use with adults seeking a diagnosis of autism. The findings from this study show that the ACIA is a promising new interview.What are the potential weaknesses of the study?: The study is small. However, it is important to run an initial test study before involving more people and resources in larger studies. Building on these results, we aim to undertake further studies on the acceptability and usefulness of the new interview with a larger number of people, including people from a range of backgrounds.How will these findings help autistic people now or in the future?: The ACIA has potential for use in adult autism clinical assessment services and as a resource for research and training. The semistructured format helps gather important and relevant information, and the interview length supports feasibility in clinical and research settings. The ACIA has the potential to streamline autism assessments and speed up the process for adults who currently wait a long time for their diagnosis.
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Affiliation(s)
- Sarah Wigham
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom.,Address correspondence to: Sarah Wigham, PhD, Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Barry Ingham
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | - Ann Le Couteur
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tom Berney
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ian Ensum
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
| | - Jeremy R. Parr
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, United Kingdom.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
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Describing the Profile of Diagnostic Features in Autistic Adults Using an Abbreviated Version of the Diagnostic Interview for Social and Communication Disorders (DISCO-Abbreviated). J Autism Dev Disord 2020; 49:5036-5046. [PMID: 31494785 PMCID: PMC6841916 DOI: 10.1007/s10803-019-04214-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The rate of diagnosis of autism in adults has increased over recent years; however, the profile of behaviours in these individuals is less understood than the profile seen in those diagnosed in childhood. Better understanding of this profile will be essential to identify and remove potential barriers to diagnosis. Using an abbreviated form of the Diagnostic Interview for Social and Communication Disorders, comparisons were drawn between the profile of a sample of able adults diagnosed in adulthood and the profile of a sample of able children. Results revealed both similarities and differences. A relative strength in non-verbal communication highlighted a potential barrier to diagnosis according to DSM-5 criteria for the adult sample, which may also have prevented them from being diagnosed as children.
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15
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Do Parental Interviews for ASD Converge with Clinical Diagnoses? An Empirical Comparison of the 3di and the DISCO in Children with ASD, a Clinically-Referred Group, and Typically Developing Children. J Autism Dev Disord 2020; 50:1324-1336. [PMID: 31907731 DOI: 10.1007/s10803-019-04344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Two semi-structured parental interviews are available with algorithms developed to measure DSM-5 criteria of ASD, namely the Developmental, Dimensional and Diagnostic Interview (3di) and the Diagnostic Interview for Social and Communication Disorders (DISCO-11). The main aim of this study was to examine the agreement between classification according to both interviews, and their convergence with the clinical diagnosis. Therefore, the 3di and DISCO-11 were administered from three groups of parents of a 4-18 year old. Results showed 75% agreement between both instruments, but in the ASD group only 16% of the children scored above threshold on both instruments. Exploratory analyses suggested that the 3di failed to detect rigid and repetitive behaviors, whereas the DISCO-11 was insufficiently sensitive in detecting socio-communicative problems.
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Rubinstein K. Psychological Diagnosis of Adults with Autism Spectrum Disorder. AUTISM IN ADULTHOOD 2019. [DOI: 10.1007/978-3-030-28833-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet 2018; 392:508-520. [PMID: 30078460 PMCID: PMC7398158 DOI: 10.1016/s0140-6736(18)31129-2] [Citation(s) in RCA: 876] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
Autism spectrum disorder is a term used to describe a constellation of early-appearing social communication deficits and repetitive sensory-motor behaviours associated with a strong genetic component as well as other causes. The outlook for many individuals with autism spectrum disorder today is brighter than it was 50 years ago; more people with the condition are able to speak, read, and live in the community rather than in institutions, and some will be largely free from symptoms of the disorder by adulthood. Nevertheless, most individuals will not work full-time or live independently. Genetics and neuroscience have identified intriguing patterns of risk, but without much practical benefit yet. Considerable work is still needed to understand how and when behavioural and medical treatments can be effective, and for which children, including those with substantial comorbidities. It is also important to implement what we already know and develop services for adults with autism spectrum disorder. Clinicians can make a difference by providing timely and individualised help to families navigating referrals and access to community support systems, by providing accurate information despite often unfiltered media input, and by anticipating transitions such as family changes and school entry and leaving.
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Affiliation(s)
- Catherine Lord
- Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Weill Cornell Medicine, Cornell University, White Plains, NY, USA.
| | - Mayada Elsabbagh
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Gillian Baird
- Evelina Children's Hospital, King's Health Partners, London, UK
| | - Jeremy Veenstra-Vanderweele
- Division of Child and Adolescent Psychiatry, Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, White Plains, NY, USA
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