Advances in Autism : 2017 - Issue 1

mercredi 8 février 2017

1. Eddie C, Jane M. Editorial. Advances in Autism ;2017 ;3(1):1-2.

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2. David M, Hannah M. Examining the experiences and quality of life of patients with an autism spectrum disorder detained in high secure psychiatric care. Advances in Autism ;2017 ;3(1):3-14.

Purpose Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and needs. There is also evidence that if detained individuals with an ASD experience particular difficulties within custodial environments as a result of a mismatch between the difficulties associated with their ASD and the environmental demands. The purpose of this paper is to explore the experience of individuals with an ASD admitted to a high secure psychiatric care (HSPC) hospital. Design/methodology/approach Using both a semi-structured interview and a quality of life self-report measure (the Lancashire Quality of Life Profile) the experiences and views of seven patients with an ASD detained in one HSPC hospital were qualitatively explored. Findings Whilst a diverse range of negative and positive aspects of being within HSPC were identified by patients interviewed, those with prison experience thought HSPC was a less stressful environment with more therapeutic opportunities. As a group, patients with an ASD reported a similar or significantly better quality of life in many domains (global, leisure, financial and living situation) compared to other detained forensic patient groups. Practical implications Although most patients with an ASD interviewed reported positive experiences, there are a number of practical improvements that could be made within the hospital to reduce experienced stress levels and perhaps improve therapeutic outcomes. Originality/value Within the context of the Department of Health’s autism strategy (2010) and subsequent update think autism (2014), the survey highlights continued ASD awareness training for staff as important. In responding to the risks and needs of individuals with an ASD in HSPC there is further support for the development of an ASD specialist service.

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3. Jane SA, Alwyn K, Tara B, Bethany W, Emma R, Bhavika P, James DC. Are we good and are we safe ? Measuring quality and assessing risk in an adult autism diagnostic service. Advances in Autism ;2017 ;3(1):15-26.

Purpose Leeds autism diagnostic service is an adult autism diagnostic service for people of any intellectual ability which also offers consultancy to service users/carers or professionals, as well as a wide range of autism training. The service was set up as a pilot in 2011 and a paper describing the service development was published in this journal in November 2015. The purpose of this paper is to describe the approach taken to measure the quality of the service the authors provide and accurately assess risk in adults with autism. Design/methodology/approach The process of evaluating appropriate outcome measures is described, along with considering appropriate risk assessment tools for use in the community. Over 200 people each year complete the autism diagnostic pathway, and 164 patients were invited to respond to service evaluation questionnaires in 2014. Findings To date, the most useful outcome measures for this group include a prospective service user questionnaire which enables service user opinion to influence service development. In the absence of any appropriate autism-specific risk assessment tools, the service has developed one which it is currently piloting. This has proved particularly useful in the consultancy setting Originality/value This paper is a follow-up paper looking at the day-to-day issues that the team have had to grapple with – how do you assess whether what you are doing is providing the best possible service for the people that you serve and how do you accurately assess risk in this population ?

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4. Anna MP, Miti M, Yona L. Changing profiles of individuals with autism spectrum disorder admitted to a specialized inpatient unit. Advances in Autism ;2017 ;3(1):27-33.

Purpose The purpose of this paper is to study the profiles of adults with autism spectrum disorder (ASD) requiring an inpatient psychiatric admission. Design/methodology/approach This paper examines profiles of 27 inpatients with intellectual disability (ID) and ASD who were admitted to a specialized inpatient unit in two time periods (January 2005 to June 2009 and July 2009 to December 2013) to explore changes over time in patient profiles. Findings Findings suggest that individuals who were admitted more recently between July 2009 and December 2013, were younger and more likely to come from other ethnic backgrounds than those admitted between January 2005 and June 2009. There was a trend for recent admissions to come from family homes, have moderate to profound ID and have longer hospital stay. Originality/value This is the first study to compare profiles of adults with ASD receiving inpatient services over time. The value of the study lies in illustrating that the needs of this growing patient group are changing which has implications for the treatment provision including specialized inpatient treatment.

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5. Debbie S, Jacqueline S, Laura H, Andreina MM, Francesca H. Cognitive behaviour therapy for social anxiety in autism spectrum disorder : a systematic review. Advances in Autism ;2017 ;3(1):34-46.

Purpose Individuals who have autism spectrum disorders (ASD) commonly experience anxiety about social interaction and social situations. Cognitive behaviour therapy (CBT) is a recommended treatment for social anxiety (SA) in the non-ASD population. Therapy typically comprises cognitive interventions, imagery-based work and for some individuals, behavioural interventions. Whether these are useful for the ASD population is unclear. Therefore, the purpose of this paper is to undertake a systematic review to summarise research about CBT for SA in ASD. Design/methodology/approach Using a priori criteria, the authors searched for English-language peer-reviewed empirical studies in five databases. The search yielded 1,364 results. Titles, abstracts, and relevant publications were independently screened by two reviewers. Findings Four single case studies met the review inclusion criteria ; data were synthesised narratively. Participants (three adults and one child) were diagnosed with ASD and SA. There were commonalities in interventions and techniques used : participants were encouraged to identify and challenge negative thoughts, enter anxiety-provoking social situations, and develop new ways of coping. Unlike CBT for SA in non-ASD individuals, treatment also included social skills interventions. Outcomes were assessed using self- or informant-reports. Improvements in SA, depressive symptoms, social skills, and activity levels were noted. Generalisability of results is hampered, however, by the small number of studies and participants and lack of randomised controlled trial conditions employed. Research limitations/implications Future studies should investigate how beliefs and behaviours indicative of SA can be ameliorated in individuals with ASD. Originality/value This is the first review to synthesise empirical data about CBT for SA in ASD.

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6. Stephen W. Diagnosing ASD with fractal analysis. Advances in Autism ;2017 ;3(1):47-56.

Purpose Neuroscience is providing new tools to potentially improve diagnosis and classification of autism spectrum disorder (ASD) based on biomarkers. The purpose of this paper, is to describe certain applications of fractal analysis, a tool used to measure information complexity observed within electroencephalograph (EEG) signals and neurogenetic code. It is argued here that a better method of diagnosis of ASD may exist based on these new tools. Design/methodology/approach Selective review of literature focused on the diagnosis of ASD and recent technological advances in scientific approaches to diagnosis of ASD. It is argued that higher levels of complex, coherent data are inversely related to pathology ; in biological systems, lower complexity EEG during specific tasks may reveal pathology. Findings Clinicians and researchers are exploring new ways to describe mental illness based on biomarkers to improve reliability and validity of diagnostic methods. Specific application of chaos theory in the form of fractal analysis shows promise as one possible method. Originality/value This is a conceptual paper addressing the advantages of employing fractal analysis of EEG and genomics for the diagnosis of ASD.

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