Advances in Autism : 2016 - Issue 3

mardi 20 septembre 2016

1. Lisa U, Jane M, Eddie C, Andrew F, Richard M, Declan M. Autism spectrum disorder traits among prisoners. Advances in Autism ;2016 ;2(3):106-117.

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.

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2. Hayley K, Jane SA. How useful are the Adult Asperger Assessment and AQ-10 within an adult clinical population of all intellectual abilities ?. Advances in Autism ;2016 ;2(3):118-130.

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.

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3. Marta ML, Tanja U, Ingrid P, Bojan C. Autism research dynamic through ontology-based text mining. Advances in Autism ;2016 ;2(3):131-139.

Purpose – The increase of prevalence of autism spectrum disorders (ASD) has been accompanied by much new research. The amount and the speed of growth of scientific information available online have strongly influenced the way of work in the research community which calls for new methods and tools to support it. The purpose of this paper is to present ontology-based text mining in the field of autism trend analysis that may help to understand the broader picture of the disorder since its discovery. Design/methodology/approach – The data sets consisted of abstracts of more than 18,000 articles on ASD published from 1943 to the end of 2012 found in MEDLINE and of the documents’ titles for all those articles where the abstracts were not available. Findings – In this way, the authors demonstrated a steeper exponential curve of ASD publications compared with all publications in MEDLINE. In addition, the main research topics over time were identified using the “open discovery” approach. Finally, the relationship between a priori setting up research topics including communication, genetics, environmental risk factors, vaccination and adulthood were revealed. Originality/value – Using ontology-based text mining the authors were able to identify the main research topics in the field of autism during the time, as well as to show the dynamics of some research topics as a priori setting up. The computerised methodology that was used allowed the authors to analyse a much larger quantity of information, saving time and manual work.

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4. Philip B, Eman S. Autistic spectrum disorders, personality disorder and offending in a transgender patient : clinical considerations, diagnostic challenges and treatment responses. Advances in Autism ;2016 ;2(3):140-146.

Purpose – The case of a woman with a history of offending and prolonged imprisonment is given. The purpose of this paper is to explore the complex interplay between diagnoses of autistic spectrum disorder (ASD), personality disorder and gender dysphoria. A discussion on useful and less useful treatment approaches follows, given the unusual and complex clinical presentation. Design/methodology/approach – This is a case report with a summary of the background to this under-researched area. Findings – The way in which the diagnostic picture clarified over time is explained. The difficulties in accurately diagnosing are put forward and strategies to address this are suggested. Successful treatment of unusual clinical problems may require highly individualised care within generic services. Originality/value – The authors know of no similar case reports in the published literature. The clinical associations between ASDs, personality disorders and gender dysphoria, in forensic mental health populations, appears to be unexplored in the literature.

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5. Kumar GS, Eddie C. Personal experiences of autism and secure units. Advances in Autism ;2016 ;2(3):147-150.

Purpose – A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues. Design/methodology/approach – X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist ’ s view, is given. Findings – There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management. Originality/value – This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient ’ s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.

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6. Eddie C, Jane M. Editorial. Advances in Autism ;2016 ;2(3):null.

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