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Kildahl AN, Helverschou SB, Bakken TL, Oddli HW. "If we do not look for it, we do not see it": Clinicians' experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1119-1132. [PMID: 32285568 DOI: 10.1111/jar.12734] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. METHOD Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. RESULTS Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. CONCLUSIONS Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Trine Lise Bakken
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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2
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Haruvi-Lamdan N, Horesh D, Zohar S, Kraus M, Golan O. Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:884-898. [PMID: 32245333 DOI: 10.1177/1362361320912143] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
LAY ABSTRACT People with Autism Spectrum Disorder show an increased risk of experiencing traumatic events, particularly social victimization. However, Autism Spectrum Disorder and Post-Traumatic Stress Disorder co-occurrence was hardly studied. We examined exposure to traumatic life events and Post-Traumatic Stress Disorder symptoms in adults with Autism Spectrum Disorder vs typical adults. Two groups took part in this study: Twenty-five adults with Autism Spectrum Disorder and 25 typical adults of similar age and male to female ratio. Participants completed questionnaires on potentially traumatic life events of social and non-social nature, as well as on Post-Traumatic Stress Disorder symptoms related to their most distressing event. Participants also filled out an autism traits questionnaire. Results showed a higher Post-Traumatic Stress Disorder rate in the Autism Spectrum Disorder group (32%) compared with the typical group (4%). Individuals with Autism Spectrum Disorder reported more Post-Traumatic Stress Disorder symptoms, particularly re-experiencing and increased physiological arousal, compared with typical adults, although the latter was elevated only in females with Autism Spectrum Disorder. Participants with Autism Spectrum Disorder, especially females, reported more negative life events, particularly social events, than typical adults. Sixty percent of Autism Spectrum Disorder participants, but only 20% of typical participants, chose a social event as their most distressing event. Individuals with Autism Spectrum Disorder who were also suspected as having Post-Traumatic Stress Disorder (based on their questionnaires) presented poorer social skills compared with those with Autism Spectrum Disorder alone. Results indicate that individuals with Autism Spectrum Disorder are more susceptible to trauma and Post-Traumatic Stress Disorder, particularly due to social stressors. Females with Autism Spectrum Disorder may be especially vulnerable to Post-Traumatic Stress Disorder.
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Affiliation(s)
| | - Danny Horesh
- Bar-Ilan University, Israel.,New York University, USA.,Autism Treatment & Research Center, Association for Children at Risk, Israel
| | | | | | - Ofer Golan
- Bar-Ilan University, Israel.,Autism Treatment & Research Center, Association for Children at Risk, Israel.,University of Cambridge, UK
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3
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Peterson JL, Earl R, Fox EA, Ma R, Haidar G, Pepper M, Berliner L, Wallace A, Bernier R. Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:529-547. [PMID: 31819782 PMCID: PMC6901292 DOI: 10.1007/s40653-019-00253-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Empirical investigations of trauma and post-traumatic stress disorder (PTSD) in individuals with autism spectrum disorder (ASD) are lacking despite indications of increased risk for exposure to potentially traumatic events in this population. Research on the treatment of traumatic stress psychopathology in ASD is even more limited and suggests a critical need for guidance in the area of ASD-specific treatment adaptations. The current paper provides preliminary recommendations for adapting current evidenced-based, trauma-specific interventions, specifically trauma-focused cognitive behavioral therapy (TF-CBT), for individuals with ASD based on well-established and evidence-based practices for working with this population. These adaptations highlight the need to incorporate treatment goals related to ASD core symptoms and associated characteristics during treatment targeting traumatic stress symptoms. Future directions are discussed, including the development of instruments measuring trauma reactions in ASD, empirical investigations of modified trauma interventions for children with ASD to evaluate effectiveness, and collaboration between professionals specializing in ASD and trauma/PTSD to advance research and facilitate effective care for this community.
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Affiliation(s)
- Jessica L Peterson
- Seattle Children's Autism Center, , 4909 25th Ave NE, Seattle, WA 98105, M/S CAC, PO Box 5371, Seattle, WA 98145-5005
| | - Rachel Earl
- University of Washington, Psychiatry and Behavioral Sciences / Seattle Children's Hospital
| | - Emily A Fox
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA / Seattle Children's Hospital, M/S CAC PO Box 5371, 508.851.0996
| | - Ruqian Ma
- University of Washington College of Education and Department of Psychiatry & Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Ghina Haidar
- University of Washington College of Education & Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Micah Pepper
- University of Washington Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Lucy Berliner
- University of Washington Medicine, Mailing Address: 325 Ninth Avenue, MS 359947 Seattle, WA 98104, 206 744-1600 (main line)
| | - Arianne Wallace
- University of Washington Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Raphael Bernier
- Department of Psychiatry & Behavioral Sciences, University of Washington, ,
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4
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Brenner J, Pan Z, Mazefsky C, Smith KA, Gabriels R. Behavioral Symptoms of Reported Abuse in Children and Adolescents with Autism Spectrum Disorder in Inpatient Settings. J Autism Dev Disord 2018; 48:3727-3735. [PMID: 28593599 DOI: 10.1007/s10803-017-3183-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to examine how behavioral manifestations of trauma due to abuse are expressed in youth with autism spectrum disorder (ASD). Analysis of covariance (ANCOVA) compared outcomes between patients with a caregiver reported history of abuse and those without. Findings indicate that patients with ASD and reported abuse (i.e. physical, sexual, and/or emotional) have more intrusive thoughts, distressing memories, loss of interest, irritability, and lethargy than those without reported maltreatment. Those with clinical diagnoses of posttraumatic stress disorder (PTSD) had more severe and externalized symptoms than those with reported abuse not diagnosed with PTSD. Results emphasize the need for trauma screening measures to guide evidence-based treatments for children with ASD.
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Affiliation(s)
- Jamie Brenner
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA. .,Insights Colorado Assessment and Therapy, 899 Logan Street, Suite 460, Denver, CO, 80203, USA.
| | - Zhaoxing Pan
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA
| | - Carla Mazefsky
- University of Pittsburgh School of Medicine, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Kahsi A Smith
- Tufts University School of Medicine, Boston, MA, USA
| | - Robin Gabriels
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA
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5
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Rumball F. A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0133-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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6
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Walters S, Loades M, Russell A. A Systematic Review of Effective Modifications to Cognitive Behavioural Therapy for Young People with Autism Spectrum Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0072-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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7
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Carrigan N, Allez K. Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder in a person with an Autism Spectrum Condition and Intellectual Disability: A Case Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:326-335. [DOI: 10.1111/jar.12243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Neil Carrigan
- Swindon Psychological Therapies Service; AWP NHS Trust; Swindon UK
| | - Kate Allez
- Community Learning Disabilities Team (North Locality); 2gether NHS Foundation Trust; Cheltenham UK
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8
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The Effects of Psychological Trauma on Children with Autism Spectrum Disorders: a Research Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2015. [DOI: 10.1007/s40489-015-0052-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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9
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Hulbert-Williams L, Hastings R, Owen DM, Burns L, Day J, Mulligan J, Noone SJ. Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:48-60. [PMID: 23627774 DOI: 10.1111/jir.12050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. METHODS Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over time was explored. RESULTS Hierarchical linear regression analyses demonstrated a contribution of life events to the prediction of later psychological problems after controlling for earlier psychological problems. Exploratory analyses showed that the relationship between life events and psychological problems might be unidirectional, and non-spurious; remaining present once the impact of other correlates of psychological problems was controlled. CONCLUSIONS These data offer support for the status of life events (with a negative valence) as a risk factor for psychological problems in adults with ID. To establish life events as a causal risk factor, research is needed to examine the mechanisms via which life events have their impact on psychological well-being.
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Affiliation(s)
- L Hulbert-Williams
- School of Applied Sciences, University of Wolverhampton, Wolverhampton, UK
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10
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Valenti M, Ciprietti T, Egidio CD, Gabrielli M, Masedu F, Tomassini AR, Sorge G. Adaptive response of children and adolescents with autism to the 2009 earthquake in L'Aquila, Italy. J Autism Dev Disord 2012; 42:954-60. [PMID: 21717269 PMCID: PMC3360871 DOI: 10.1007/s10803-011-1323-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The literature offers no descriptions of the adaptive outcomes of people with autism spectrum disorder (ASD) after natural disasters. Aim of this study was to evaluate the adaptive behaviour of participants with ASD followed for 1 year after their exposure to the 2009 earthquake in L'Aquila (Italy) compared with an unexposed peer group with ASD, by administering the Italian form of the Vineland Adaptive Behaviour Scales (VABS) at baseline, 6 months and 1 year after the earthquake. Exposed participants declined dramatically in their adaptive behaviour during the first months after the earthquake (p < 0.01 for all VABS dimensions). However, immediate intensive post-disaster intervention allowed children and adolescents with autism showing a trend towards partial recovery of adaptive functioning.
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Affiliation(s)
- Marco Valenti
- Department of Medicine and Public Health, University of L'Aquila, Coppito Hospital Building Delta 6, 67100 L'Aquila, Italy.
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12
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Hutton J, Goode S, Murphy M, Le Couteur A, Rutter M. New-onset psychiatric disorders in individuals with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2008; 12:373-90. [PMID: 18579645 DOI: 10.1177/1362361308091650] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A follow-up study to at least the age of 21 years of 135 individuals with an autism spectrum disorder diagnosed in childhood and an IQ of over 30 was conducted. The study is distinctive in its large size, low attrition rate and use of systematic interviews to obtain clinical information. Questionnaires completed by caregivers asked about the development of new psychiatric disorders. For the 39 individuals with a possible new disorder, a detailed psychiatric assessment was undertaken through parental interview. Of all participants, 16 percent developed a definite new psychiatric disorder. A further 6 percent developed a possible new disorder. Five individuals developed an obsessive-compulsive disorder and/or catatonia; eight an affective disorder with marked obsessional features; three complex affective disorders; four more straightforward affective disorders; one a bipolar disorder; and one an acute anxiety state complicated by alcohol excess. There was no case of schizophrenia.
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Affiliation(s)
- Jane Hutton
- Department of Psychological Medicine, Institute of Psychiatry, London, UK.
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13
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Randall P, Parker J. Factitious Disorder by Proxy and the Abuse of a Child with Autism. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2007. [DOI: 10.1080/0266736970130108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin JA. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. CHILD ABUSE & NEGLECT 2005; 29:1359-72. [PMID: 16293306 DOI: 10.1016/j.chiabu.2005.06.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2004] [Revised: 05/31/2005] [Accepted: 06/13/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. METHODS Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. RESULTS Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. CONCLUSION Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.
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Affiliation(s)
- David S Mandell
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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15
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Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin J. Characteristics of Children with Autistic Spectrum Disorders Served in Comprehensive Community-based Mental Health Settings. J Autism Dev Disord 2005; 35:313-21. [PMID: 16119472 DOI: 10.1007/s10803-005-3296-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study describes the characteristics of children with autistic spectrum disorders (ASD) receiving treatment in community mental health settings. Data from a national community mental health initiative was used to identify children who had received a primary diagnosis of ASD. These children were compared with children with other diagnoses on socio-demographic and psychosocial characteristics, presenting problems and service histories. Regardless of diagnosis, children were most often referred to service because of disruptive behaviors. Children with ASD were less likely to be referred for drug use, truancy or running away, but were more likely to be referred for social interaction difficulties and strange behavior. Many children had family histories of mental illness, substance abuse and domestic violence. Implications of these findings are discussed in detail.
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Affiliation(s)
- David S Mandell
- Center for Mental Health Policy and Services Research, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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Hastings RP, Hatton C, Taylor JL, Maddison C. Life events and psychiatric symptoms in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:42-6. [PMID: 14675230 DOI: 10.1111/j.1365-2788.2004.00584.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Previous research has indicated that children and adults with intellectual disabilities (ID) may respond to traumatic and other life events in a similar way to the general population. However, few studies have charted the extent of exposure to recent life events in samples of adults with ID and the association of such exposure with general psychiatric problems. METHODS Adults with ID (n = 1155) in community and residential services in a county district in North-east England were assessed using the Psychiatric Assessment for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist), which includes a checklist of recent life events. Data were provided by informants who knew the index client well. RESULTS Within the 12 months before data collection, the five most frequently experienced life events were: moving residence (15.5% of sample), serious illness of close relative or friend (9.0%), serious problem with close friend, neighbour or relative (8.8%), serious illness or injury to self (8.5%), and death of close family friend or other relative (8.3%). Overall, 46.3% had experienced one or more significant life events in the previous 12 months and 17.4% had experienced two or more. Logistic regression analysis revealed that the presence of one or more life events in the previous 12 months added significantly to the classification of psychiatric caseness predicted by demographic variables (age, sex, residence in community or hospital) on the PAS-ADD Affective Disorder scale. Overall, the odds ratio for affective disorder given exposure to one or more life events was 2.23 [95% confidence interval (CI) = 1.56, 3.18]. CONCLUSIONS Small, but potentially significant relationships were found between life events exposure and psychiatric problems in adults with ID. Further research is needed to explore the causal direction of this relationship and also to develop more sensitive measures of life events relevant to the situation of adults in residential and community service environments.
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Affiliation(s)
- R P Hastings
- School of Psychology, University of Wales Bangor, Gwynedd, UK.
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Abstract
Many different treatments have been claimed to have a dramatic impact on children with autism. This paper reviews what is known about the outcome in adult life and examines the limitations and advantages of a variety of intervention approaches. It concludes that there is little evidence of any "cure" for autism, but appropriately structured programmes for education and management in the early years can play a significant role in enhancing functioning in later life.
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Affiliation(s)
- P Howlin
- Department of Psychology, St. George's Hospital Medical School, Tooting, London, United Kingdom
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Howlin P, Clements J. Is it possible to assess the impact of abuse on children with pervasive developmental disorders? J Autism Dev Disord 1995; 25:337-54. [PMID: 7592248 DOI: 10.1007/bf02179372] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although it is now recognized that children may exhibit widespread symptoms of stress following exposure to abuse or neglect, the impact of traumatic experiences on children with pervasive developmental disorders has received little attention. The present paper describes a strategy devised to assess the long-term effects of abuse on a group of children who had attended a specialist autistic school where physical and emotional mistreatment of pupils was well documented. Because most of the children had very limited communication skills, the evidence relied heavily on retrospective parental reports. Despite the problems inherent in using such data it was possible to derive reliable measures that could be used to test hypotheses about predicted patterns of behavioral change, based on work with other children who have been abused. In most cases, too, parental reports could be corroborated by information from other sources. Consistent patterns in both the nature and timing of behavioral disturbances were found, which seemed to relate specifically to the period of abuse at the school.
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Affiliation(s)
- P Howlin
- St George's Hospital Medical School, London
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