Le numéro d’avril 2020 de la revue Child and Adolescent Psychiatric Clinics of North America est consacré au TSA :

Autism Spectrum Disorder Across the Lifespan : Part I

1. Shulman C, Esler A, Morrier MJ, Rice CE. Diagnosis of Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 253-73.

Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.

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2. Shulman C, Rice CE, Morrier MJ, Esler A. The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 275-99.

The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual’s symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual’s particular ASD profile.

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3. Pandina G, Ring RH, Bangerter A, Ness S. Current Approaches to the Pharmacologic Treatment of Core Symptoms Across the Lifespan of Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 301-17.

There are no approved medications for autism spectrum disorder (ASD) core symptoms. However, given the significant clinical need, children and adults with ASD are prescribed medication off label for core or associated conditions, sometimes based on limited evidence for effectiveness. Recent developments in the understanding of biologic basis of ASD have led to novel targets with potential to impact core symptoms, and several clinical trials are underway. Heterogeneity in course of development, co-occurring conditions, and age-related treatment response variability hampers study outcomes. Novel measures and approaches to ASD clinical trial design will help in development of effective pharmacologic treatments.

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4. Flannery KA, Wisner-Carlson R. Autism and Education. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 319-43.

Determining the most effective strategies to educate children and youth with autism spectrum disorder (ASD) can be daunting. Dr Stephen Shore, an autism advocate who is on the spectrum, said, « If you’ve met one person with autism, you’ve met one person with autism. » Individuals diagnosed with ASD present with unique strengths and difficulties and experience characteristics of their disability in different ways. General and special educators must be prepared with a variety of evidence-based practices and instructional strategies to engage and educate students diagnosed with autism. This article discusses current methods, techniques, evidence, and controversies for educating individuals diagnosed with autism.

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5. Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 345-58.

The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people’s success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.

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6. Moody CT, Laugeson EA. Social Skills Training in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 359-71.

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

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7. Schall C, Wehman P, Avellone L, Taylor JP. Competitive Integrated Employment for Youth and Adults with Autism : Findings from a Scoping Review. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 373-97.

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

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8. Elster N, Parsi K. Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder : An Overview of Planning and Legal Issues. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 399-408.

The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.

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9. Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 409-17.

There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.

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10. Pazuniak M, Pekrul SR. Obsessive-Compulsive Disorder in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 419-32.

Obsessive-compulsive disorder is a relatively common disorder seen in autism spectrum disorder across the lifespan. Many obsessive-compulsive disorder symptoms can present similarly to the core features of autism spectrum disorder and it is often difficult to differentiate between obsessive-compulsive disorder and stereotypic behaviors or restricted interests in autism spectrum disorder. However, there are differences between the 2 disorders. This article is a review of the current literature with the goal of helping the clinician to diagnose and treat obsessive-compulsive disorder in a patient with autism spectrum disorder.

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11. Wisner-Carlson R, Pekrul SR, Flis T, Schloesser R. Autism Spectrum Disorder Grows Up. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : xiii-xvi.

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