Screening tools for autism spectrum disorders

Pre-pregnancy ozone and ultrafine particulate matter exposure during second year of life associated with decreased cognitive and adaptive functioning at aged 2-5 years

BACKGROUND

This study sought to investigate the association of prenatal and early life exposure to a mixture of air pollutants on cognitive and adaptive outcomes separately in children with or without autism spectrum disorder (ASD).

METHODS

Utilizing data from the CHARGE case-control study (birth years: 2000-2016), we predicted daily air concentrations of NO2, O3, and particulate matter <0.1 μm (PM0.1), between 0.1 and 2.5 μm (PM0.1-2.5), and between 2.5 and 10 μm (PM2.5-10) using chemical transport models with ground-based monitor adjustments. Exposures were evaluated for pre-pregnancy, each trimester, and the first two years of life. Individual and combined effects of pollutants were assessed with Vineland Adaptive Behavior Scales (VABS) and Mullen Scales of Early Learning (MSEL), separately for children with ASD (n = 660) and children without ASD (typically developing (TD) and developmentally delayed (DD) combined; n = 753) using hierarchical Bayesian Kernel Machine Regression (BKMR) models with three groups: PM size fractions (PM0.1, PM0.1-2.5, PM2.5-10), NO2, and O3.

RESULTS

Pre-pregnancy Ozone was strongly negatively associated with all scores in the non-ASD group (group posterior inclusion probability (gPIP) = 0.83-1.00). The PM group during year 2 was also strongly negatively associated with all scores in the non-ASD group (gPIP = 0.59-0.93), with PM0.1 driving the group association (conditional PIP (cPIP) = 0.73-0.96). Weaker and less consistent associations were observed between PM0.1-2.5 during pre-pregnancy and ozone during year 1 and VABS scores in the ASD group.

CONCLUSIONS

These findings prompt further investigation into ozone and ultrafine PM as potential environmental risk factors for neurodevelopment.

Machine learning-based early diagnosis of autism according to eye movements of real and artificial faces scanning

Background

Studies on eye movements found that children with autism spectrum disorder (ASD) had abnormal gaze behavior to social stimuli. The current study aimed to investigate whether their eye movement patterns in relation to cartoon characters or real people could be useful in identifying ASD children.

Methods

Eye-tracking tests based on videos of cartoon characters and real people were performed for ASD and typically developing (TD) children aged between 12 and 60 months. A three-level hierarchical structure including participants, events, and areas of interest was used to arrange the data obtained from eye-tracking tests. Random forest was adopted as the feature selection tool and classifier, and the flattened vectors and diagnostic information were used as features and labels. A logistic regression was used to evaluate the impact of the most important features.

Results

A total of 161 children (117 ASD and 44 TD) with a mean age of 39.70 ± 12.27 months were recruited. The overall accuracy, precision, and recall of the model were 0.73, 0.73, and 0.75, respectively. Attention to human-related elements was positively related to the diagnosis of ASD, while fixation time for cartoons was negatively related to the diagnosis.

Conclusion

Using eye-tracking techniques with machine learning algorithms might be promising for identifying ASD. The value of artificial faces, such as cartoon characters, in the field of ASD diagnosis and intervention is worth further exploring.

Autism in Women

Relative to males, women with autism spectrum disorder (ASD) have neurobiological and clinical presentation differences. Recent research suggests that the male/female ASD prevalence gap is smaller than previously reported. Sex differences in symptom presentation as well as the male bias of ASD account for delayed/missed diagnosis among women. Investigating ASD and providing psychological evaluation referrals for women who are struggling socially and present with complex mental health conditions (e.g., ADHD, depression), even when they do not show typical autistic characteristics, is important. Accurate diagnosis facilitates understanding of challenges, increases access to treatments, and alleviates the burden of ASD.

Adults with autism spectrum disorder and the criminal justice system: An investigation of prevalence of contact with the criminal justice system, risk factors and sex differences in a specialist assessment service

LAY ABSTRACT

There has been growing interest in offending and contact with the criminal justice system (CJS) by people with autism spectrum disorder (ASD). However, it is not clear whether people with ASD offend more than those without ASD. Studies have started to look at whether there are particular offences people with ASD are more likely to commit and whether there are any factors that can affect whether someone comes into contact with the CJS as a potential suspect. This study looked at the patients who attended an ASD diagnostic service over a 17-year period to see the rate of contact with the CJS of those who were diagnosed with ASD and whether there were any particular factors that might increase the risk of CJS contact. Nearly a quarter of the ASD group had some contact with the CJS as a potential suspect. Factors that seemed to increase whether someone with ASD was more likely to have contact with the CJS were being male, being diagnosed with ADHD, and being diagnosed with psychosis. This study is one of the largest studies to investigate the rate of CJS contact as a potential suspect in a sample of adults with ASD in an attempt to give a clearer picture of what might influence someone with ASD to engage in offending behaviour in order to try to see what mental health services can offer to reduce the likelihood of someone with ASD coming into contact with the CJS, for example, treatment for another condition or support.

"I'm Human After All": Autism, Trauma, and Affective Empathy

Academic literature has long associated autism with empathy deficits. Although this view has been attenuated over time to include only cognitive empathy, earlier perceptions continue to influence popular representations of autism and screening/diagnostic tools. As a result, empathetic autistics may be prevented from accessing diagnosis, and those with a diagnosis may experience internalized stigma or violence under the guise of therapy. There are, however, some autistics who do self-identify as having empathy difficulties. The purpose of this perspective piece was to first trouble the view of empathy "deficit" as intrinsic within autism and consider alternative explanations and, second, to more deeply consider post-traumatic stress disorder (PTSD) as a factor for autistic people who self-identify as having empathy difficulties. Using both literature and author narrative, we argue that autistics are more likely to experience trauma and more vulnerable to developing PTSD, but less likely to receive a diagnosis of PTSD than nonautistics, as their PTSD-related symptoms, such as a lack of affective empathy, may be conflated with autism traits. Our main recommendations are: (1) future studies should investigate the possible interactions between autism, trauma, PTSD, and affective empathy, determining whether autistic adults with PTSD may recover affective empathy following therapy; (2) clinicians should look beyond autism if their client identifies a lack of affective empathy as part of their challenges; (3) and clinicians should adapt diagnostic procedures for PTSD in autistic adults to accommodate those with alexithymia, and exercise caution when using screening tools for autism, allowing empathic autistic adults to access diagnosis.

Lay summary

What is the topic of this article and why is it important?: Many people believe that autism causes a lack of empathy. This belief is a problem because it denies the lived experience of autistic adults and makes them appear as less than human. It can also lead to violence against autistics, and it can mean that empathic autistic adults miss out on an autism diagnosis. As a result, they may not be able to access necessary supports. This situation may cause suffering for autistic adults.What is the perspective of the authors?: R.H. is an autistic woman diagnosed in adulthood, who is often overwhelmed by too much empathy. She worked as an employment mentor for autistics and is now a PhD candidate researching relationship-building between autistic service users and their support professionals. H.B. is an autistic man diagnosed in childhood. As a teenager, he was also diagnosed with post-traumatic stress disorder (PTSD), a mental disorder caused by trauma. He did not feel any empathy for most of his life and felt very distressed by this, as he thought that it was a permanent trait of his autism. However, he started feeling empathy after trauma therapy and falling in love. Both authors believe that autistic adults can experience all forms of empathy.What arguments do the authors make?: The authors cite research that shows other reasons which may explain the autism-empathy myth: (1) nonautistics may not recognize empathy in autistics because of mutual differences, (2) nonautistics may not believe autistics who say they have empathy because old research suggested that this is impossible, and (3) empathy research on autistics may not be correct because it uses inappropriate methods. The authors then suggest that unrecognized PTSD may be the reason why some autistics have difficulties in this area. They think so because PTSD can shut down emotional empathy. Autistics are more likely to experience trauma, more vulnerable to developing PTSD, and less likely to receive a diagnosis of PTSD than nonautistics.What do the authors recommend?: 1.Researchers should work with autistic adults who report difficulty in feeling empathy to determine whether they may have PTSD and/or recover empathy after trauma therapy.2.Professionals who support autistic adults should look beyond autism if their client identifies a lack of empathy as part of their challenges.3.Clinicians should treat questions relating to empathy with caution when using autism screening/diagnostic tools, allowing empathic autistic adults to access diagnosis and appropriate supports.How will these recommendations help autistic adults now or in the future?: We hope that this will lead to better support for autistics who have PTSD, and less biased referral and diagnostic procedures for those who do not. We also hope that autistic adults might feel less stigma by suggesting PTSD, not autism, as the underlying cause if they have difficulties feeling empathy.

AAA screening in adults with ASD: a retrospective cohort study

Purpose

The Adult Asperger Assessment (AAA), comprising the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire is a commonly used screening tool designed to identify adults who may benefit from a further clinical assessment for autism spectrum disorder. The purpose of this paper is to investigate the usefulness of this screening measure in a clinical setting.

Design/methodology/approach

This retrospective cohort study comprised of 192 service users referred for diagnostic assessment of Autism by a specialist service of the National Health Service. The authors evaluated the diagnostic accuracy of the AAA by investigating if the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire were able to predict the diagnostic outcome of Autism in a clinical setting.

Findings

Scores from the Relatives Questionnaire can accurately predict diagnostic outcome. No evidence of accuracy for the Autism Questionnaire or the Empathy Quotient was apparent. Based on the findings, the authors recommend clinicians are cautious when interpreting results of the AAA.

Research limitations/implications

It should be acknowledged that the results may not be generalisable to whole populations. Also, the authors used the full item versions of the scales; therefore, the findings are most applicable to studies which did similar.

Originality/value

This study highlights the need for investigation into the lack of validation of commonly used screening measures in autistic populations.

Autism screening and conditional cash transfers in Chile: Using the Quantitative Checklist (Q-CHAT) for early autism detection in a low resource setting

LAY ABSTRACT

Getting a diagnosis of autism can take long, because autism is different across people, but also because it depends on the way it gets diagnosed. This is especially important in poorer countries or in the case of poor people living in wealthier countries that have significant groups of disadvantaged communities. We adapted a 10-item version of the Q-CHAT-25 questionnaire for use in routine health check-ups programme in Chile and recruited 287 participants under the age of three divided into three groups: Controls (125), Developmental Delay (149) and Autism Spectrum Condition (13). Our results show that a short questionnaire for autism screening can be successfully applied in a health-check programme in poor resource settings. Our results show that our questionnaire had good overall performance, not different to its longer version, the Q-CHAT-25. Our questionnaire was autism specific, with good sensitivity and reliability, and is suitable to be used in a screening setting. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 provides value for money and improves diagnosis of Autism Spectrum Condition in those participating in routine health check-up programmes in developing countries or poor areas of wealthy countries.

The impact of emotional development in people with autism spectrum disorder and intellectual developmental disability

BACKGROUND

Intellectual developmental disabilities (IDDs) and autism spectrum disorders (ASDs) are developmental conditions, which may also be associated with impairments in emotional development (ED). ED can be assessed using the Scale of Emotional Development - Short (SED-S), a five-stage model consisting of eight domains, which allows to study the relationship between ASD and ED in people with IDD.

METHODS

In this retrospective study, the level of ED was compared in 327 adults with IDD with [n = 83; mean age 38.3 years; level of IDD: mild (6), moderate (21), severe (45) and profound (11)] and without [n = 244, mean age 36.9 years; level of IDD: mild (67), moderate (73), severe (68) and profound (36)] ASD. The discriminative ability of the SED-S was determined by a regression in a training and a validation sample.

RESULTS

The level of ED correlated with the severity of IDD (r_s  = -.654) and the presence of ASD (r_s  = -.316). People with additional ASD showed lower levels of ED compared with those with IDD only (mean reference ages 7-18 vs 19-36 months). The developmental profiles were equally balanced in ASD and IDD-only. A regression analysis revealed three domains ('Relating-to-Peers', 'Differentiating-Emotions', and 'Regulating-Affect') to be useful for ASD assignment (AUC > 0.70, sensitivity 0.76-0.80, specificity 0.62-0.63).

CONCLUSIONS

In people with IDD, additional ASD was associated with delays in ED, which may be considered in diagnostics, treatment and care.

Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers

The present study provides a systematic review of level 1 and level 2 screening tools for the early detection of autism under 24 months of age and an evaluation of the psychometric and measurement properties of their studies. Methods: Seven databases (e.g., Scopus, EBSCOhost Research Database) were screened and experts in the autism spectrum disorders (ASD) field were questioned; Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and Consensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist were applied. Results: the study included 52 papers and 16 measures; most of them were questionnaires, and the Modified-CHecklist for Autism in Toddler (M-CHAT) was the most extensively tested. The measures' strengths (analytical evaluation of methodological quality according to COSMIN) and limitations (in term of Negative Predictive Value, Positive Predictive Value, sensitivity, and specificity) were described; the quality of the studies, assessed with the application of the COSMIN checklist, highlighted the necessity of further validation studies for all the measures. According to COSMIN results, the M-CHAT, First Years Inventory (FYI), and Quantitative-CHecklist for Autism in Toddler (Q-CHAT) seem to be promising measures that may be applied systematically by health professionals in the future.

Early Autism Screening: A Comprehensive Review

Autistic spectrum disorder (ASD) refers to a neurodevelopmental condition associated with verbal and nonverbal communication, social interactions, and behavioural complications that is becoming increasingly common in many parts of the globe. Identifying individuals on the spectrum has remained a lengthy process for the past few decades due to the fact that some individuals diagnosed with ASD exhibit exceptional skills in areas such as mathematics, arts, and music among others. To improve the accuracy and reliability of autism diagnoses, many scholars have developed pre-diagnosis screening methods to help identify autistic behaviours at an early stage, speed up the clinical diagnosis referral process, and improve the understanding of ASD for the different stakeholders involved, such as parents, caregivers, teachers, and family members. However, the functionality and reliability of those screening tools vary according to different research studies and some have remained questionable. This study evaluates and critically analyses 37 different ASD screening tools in order to identify possible areas that need to be addressed through further development and innovation. More importantly, different criteria associated with existing screening tools, such as accessibility, the fulfilment of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifications, comprehensibility among the target audience, performance (specifically sensitivity, specificity, and accuracy), web and mobile availability, and popularity have been investigated.

Diagnostic Assessment Techniques and Non-Invasive Biomarkers for Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex heterogeneous neurological disorder that has led to a spectrum of diagnosis techniques. The screening instruments, medical and technological tools initiate the diagnosis process. Clinicians and psychologists propose therapies depending on the examination done by these methodologies. The literature has accounted dozens of diagnostic methods and alternative and complementary therapies but still lack in highlighting the proper biomarker for early detection and intervention. The emerging multi-modal neuro-imaging techniques have correlated the brain's functional and structural measures and diagnosed ASD with more sensitivity than individual approaches. The purpose of this review article is: (i) to provide an overview of the emerging ASD diagnosis methods and different markers and; (ii) to present the idea of integrating all the individual methods in to a multi-modal diagnostic system to enhance detection sensitivity. This system possesses the potential to diagnose and predict ASD clinically, neurologically & objectively with high detection sensitivity.

Diagnosing Autism in Adults with Intellectual Disability: Validation of the DiBAS-R in an Independent Sample

The study assessed the diagnostic validity of the diagnostic behavioral assessment for autism spectrum disorders-revised (DiBAS-R; 19-item screening scale based on ratings by caregivers) in a clinical sample of 381 adults with ID. Analysis revealed a sensitivity of 0.82 and a specificity of 0.67 in the overall sample (70.3% agreement). Sensitivity (0.79) and specificity (0.84) were balanced in individuals with mild to moderate ID (83.3% agreement), while specificity was lower in individuals with severe to profound ID (sensitivity: 0.83, specificity: 0.34, 51% agreement). The level of ID as well as its interaction with ASD explained a significant proportion of the variance in the DiBAS-R scores. The DiBAS-R is an adequate screening tool, especially in individuals with mild to moderate ID.

Relationships between the social communication questionnaire and pragmatic language, socialization skills, and behavioral problems in children with autism spectrum disorders

The Social Communication Questionnaire (SCQ) is one of the most widely used screening instruments for autism spectrum disorder (ASD). This study examined the relationships between the reciprocal social interaction, communication, and repetitive/stereotyped factors on the Strength and Difficulties Questionnaire (SDQ) and pragmatic, socialization, and behavioral problems in children with ASD and children with typical development (TD). Participants were seven- to 11-year-old children with ASD without intellectual disability (n = 52) and with TD (n = 37). The two groups were matched on age and intelligence quotient. Significant differences were found between the two groups on the SCQ domains and the outcome measures (pragmatic language, socialization skills, and behavioral problems). Furthermore, multiple regression analysis exploring the relationships between the SCQ and the criterion variables showed that reciprocal social interaction and repetitive/stereotyped behaviors had an important weight in the prediction of daily life social skills in typically developing children (34%). However, the model with the highest percentage of explained variance in children with ASD involved pragmatic language, with reciprocal social interaction as the best predictor, even reaching 41%. The findings highlight the suitability of routinely including the SCQ in the first stage of assessment protocols for ASD, and, in particular, they show its capacity to predict a valuable repertoire of behaviors.

Similarities and Differences in Theory of Mind Responses of Patients With Anorexia Nervosa With and Without Autistic Features

Theory of Mind (ToM) is the ability to understand and represent mental states of others, a skill that plays a key role in how we interact with people around us. Difficulties with ToM have been posited as an underlying mechanism for autism and implicated in difficulties faced by those with anorexia nervosa (AN). This study examined, both quantitatively and qualitatively, the responses of women between the ages of 14 and 25 years on the Frith-Happé Triangle Animations, a well-validated test of ToM. Participants were split into healthy controls (HCs), AN patients (AN), and AN patients with high levels of autistic features (AN+ASF). We found no significant quantitative differences between groups in performance on the task. Qualitatively, there were differences between groups such that AN patients, especially those in the AN+ASF group, were more focused on describing the videos than creating narratives, were more negative in their interpretations, and were much more anxious about their performance. These qualitative differences have clinical implications, including that not all AN patients with autistic features should be assumed to have difficulties with ToM.

The prevalence of autistic traits in a homeless population

Anecdotal evidence suggests that autistic people experience an elevated risk of homelessness, but systematic empirical research on this topic is lacking. As a step towards filling this gap in knowledge, we conducted a preliminary investigation of the prevalence of Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism symptoms in a group of long-term homeless people. The entire caseload ( N = 106) of a UK homeless outreach team was screened (excluding individuals born outside of the United Kingdom or Republic of Ireland) using an in-depth, semi-structured interview with keyworkers, based on Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. This showed adequate inter-rater reliability, as well as evidence of criterion and construct validity. Of the sample, 13 people (12.3%, 95% confidence interval (7.0, 20.4)) screened positive, meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism criteria by keyworker report. A further nine people (8.5%, 95% confidence interval (4.5, 15.3)) were ‘marginal’, having autistic traits that were not quite sufficient to meet Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Those with elevated autistic traits, compared to those without, tended to be more socially isolated and less likely to use substances. This study has provided initial evidence that autistic traits are over-represented among homeless people and that autistic homeless people may show a distinct pattern of characteristics and needs. Further investigation is required to build upon these provisional findings.

Measurement properties of screening and diagnostic tools for autism spectrum adults of mean normal intelligence: A systematic review

BACKGROUND

The autism spectrum (AS) is a multifaceted neurodevelopmental variant associated with lifelong challenges. Despite the relevant importance of identifying AS in adults for epidemiological, public health, and quality of life issues, the measurement properties of the tools currently used to screen and diagnose adults without intellectual disabilities (ID) have not been assessed.

OBJECTIVES

This systematic review addresses the accuracy, reliability, and validity of the reported AS screening and diagnostic tools used in adults without ID.

METHODS

Electronic databases and bibliographies were searched, and identified papers evaluated against inclusion criteria. The PRISMA statement was used for reporting the review. We evaluated the quality of the papers using the COSMIN Checklist for psychometric data, and QUADAS-2 for diagnostic data. For the COSMIN assessment, evidence was considered to be strong when several methodologically good articles, or one excellent article, reported consistent evidence for or against a measurement property. For the QUADAS ratings, evidence was considered to be "satisfactory" if at least one study was rated with a low risk of bias and low concern about applicability.

RESULTS

We included 38 articles comprising 32 studies, five reviews, and one book chapter and assessed nine tools (three diagnostic and six screening, including eight of their short versions). Among screening tools, only AQ-50, AQ-S, and RAADS-R and RAADS-14 were found to provide satisfactory or intermediate values for their psychometric properties, supported by strong or moderate evidence. Nevertheless, risks of bias and concerns on the applicability of these tools limit the evidence on their diagnostic properties. We found that none of the gold standard diagnostic tools used for children had satisfactory measurement properties.

CONCLUSION

There is limited evidence for the measurement properties of the screening and diagnostic tools used for AS adults with a mean normal range of measured intelligence. This may lessen the validity of conclusions and public health decisions on an important fraction of the adult autistic population. This not only justifies further validation studies of screening and diagnostic tools for autistic adults, but also supports the parallel use of self-reported information and clinical expertise with these instruments during the diagnostic process.

Autism spectrum disorder traits among prisoners

Purpose

– The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.

Design/methodology/approach

– ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey.

Findings

– There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England.

Originality/value

– Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.

How useful are the Adult Asperger Assessment and AQ-10 within an adult clinical population of all intellectual abilities?

Purpose

– The Adult Asperger Assessment (AAA) was designed to be a screening tool to identify adults with Asperger syndrome and/or high-functioning autism. The AAA includes three questionnaires; the Autism Quotient (AQ), the Empathy Quotient (EQ) and the Relatives Questionnaire (RQ). The Autism Quotient-10 (AQ-10) was designed to be a “red flag” for healthcare professionals considering referral for ASD assessment. The purpose of this paper is to determine the usefulness of the AAA and AQ-10 as part of an adult autism diagnostic pathway that includes patients of all intellectual ability.

Design/methodology/approach

– Results were obtained for all patients who had received a clinical decision at Leeds Autism Diagnostic Service, which is a service that assesses patients of all intellectual ability, during 2015, n=214. Of these 132 were included in the analysis, 77 patients were excluded for not completing the AAA and four were excluded for not receiving a clinical decision.

Findings

– Results suggest that patients diagnosed with ASD without intellectual disabilities score on average 35 on the AQ, 17 on the EQ and 20 on the RQ. Those not diagnosed with ASD score on average 33 on the AQ, 22 on the EQ and 15 on the RQ. Patients with intellectual disabilities, scores are lower on the AQ, and higher on the EQ and RQ than those without intellectual disabilities. These results are the same regardless of diagnosis of ASD. The RQ is the only questionnaire to result in a significant difference between those diagnosed and not diagnosed. Results suggest that the AQ-10 is not useful in this clinical population.

Research limitations/implications

– This study was undertaken as part of a service development improvement process. The specific demographics of this clinical population may have influenced the findings. The process will need to be repeated to ensure that the results are consistent across time and increased sample size. The population of patients with an intellectual disability is small, further studies into the use of the AAA or the design of other intellectual disability specific screening tools should be pursued. It is of note that the AAA was never intended for use within an intellectual disability population.

Originality/value

– This is an original paper as it will be the first to consider the usefulness of each of the aspects of the AAA collectively. It will be the first to assess: the AQ-10 alongside the AAA, the usefulness of the AAA regardless of intellectual ability and the usefulness of the AAA within a clinical population by using the diagnostic outcome as the benchmark of the usefulness of the AAA scores. This paper will only be discussing the scores generated by the AAA, and the correlation of these scores with a diagnosis.

Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL

BACKGROUND

Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument.

METHOD

A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed.

RESULTS

While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used.

CONCLUSIONS

Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy.

Advances in Tuberous Sclerosis Complex (TSC) research

Purpose

– The purpose of this paper is to provide a brief, descriptive overview of Tuberous Sclerosis Complex (TSC) research with particular reference to studies on Autism Spectrum Disorder (ASD).

Design/methodology/approach

– A search of electronic databases was carried out to identify English language articles on TSC. The literature was explored in more detail with a focus on neurodevelopmental disorders associated with TSC such as ASD.

Findings

– The review included 3,679 references. The earliest articles identified were published in the early twentieth century. Since then research on TSC has advanced rapidly and is being carried out worldwide. Just 62 studies have focused on ASD in TSC, although the number of publications is increasing over time.

Research limitations/implications

– More research on ASD in TSC is needed to benefit those affected by TSC and the broader ASD scientific community.

Practical implications

– Practitioners working with children and adults with ASD should be aware of the wider health issues experienced by those with genetic conditions such as TSC. Similarly, clinicians working with those who have TSC should be aware of the high prevalence of ASD in the group and implications for the way they work with their patients.

Originality/value

– This is the first paper to map and characterise the scientific literature on TSC. There remains a focus on the biomedical aspects of TSC with fewer studies on psychosocial/educational or family impacts. The review concludes with recommended research questions for the future.

Autism spectrum disorder, attention-deficit hyperactivity disorder and offending

Purpose

– A wealth of research on autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) has led to increased understanding and identification of each of these developmental disorders. Existing literature has sparked controversial discussions regarding whether aspects of ASD and ADHD predispose individuals to criminality. The purpose of this paper is to explore the link between these conditions and offending.

Design/methodology/approach

– A review of the literature on ASD, ADHD and offending was undertaken. This paper looks at the particular focus of the literature on the involvement of individuals with ADHD and ASD within the criminal justice system.

Findings

– There is some evidence of a link between ADHD and criminality. However, the relationship between ASD and offending is a little more difficult to ascertain. Complicating this further is the relatively unexplored subject of comorbid ASD/ADHD and criminal behaviour. This paper found that additional cognitive deficits and conduct problems are associated with comorbid ASD/ADHD, highlighting the need for further research and development of interventions.

Originality/value

– This paper seeks to examine whether predictions can be made with regards to what offending behaviour may look like in an individual with comorbid ASD/ADHD. This paper reviews the literature on offending in relation to both disorders to examine whether predictions can be made with regards to what the offending behaviour of an individual with ASD and ADHD may look like.