Psychopathology: Differences among adults with intellectually disabled,comorbid autism spectrum disorders and epilepsy

The goal of this study was to systematically examine group differences among adults with intellectual disabilities (ID), comorbid autism spectrum disorders (ASD), and epilepsy through a detailed exploration of the characteristics that these disorders present in the area of psychopathology. Previous studies indicating that individuals with ID have comorbid ASD and epilepsy tend to stop short of addressing these disorders’ impact on the full range of psychosocial issues, particularly in adult samples. Assessment of psychopathology was made with the ASD-comorbidity-adult version (ASD-CA). One hundred participants, with ID held constant, were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, results of the MANOVA revealed significant differences among groups, Wilks's Λ = .76, F(15, 254) = 1.82, p < .05, η² = .09. A one-way ANOVA was conducted for each of the five subscales of the ASD-CA as follow-up tests to the MANOVA. Groups differed significantly Anxiety/Repetitive Behavior subscale, F(3, 96) = 2.93, p < .05, η² = .08, Irritability/Behavior excess subscale, F(3, 96) = 4.74, p < .01, η² = .13, Attention/Hyperactivity subscale, F(3, 96) = 5.18, p < .01, η² = .14, and Depressive Symptoms subscale, F(3, 96) = 3.73, p < .01, η² = .10. Trend analysis demonstrated that individuals with ID expressing combined comorbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single comorbid factor with ID (ASD or epilepsy only). Implications of these findings elucidate the nature of these disorders and their influence on patient care and management.     

Behavior problems: Differences among intellectually disabled adults with co-morbid autism spectrum disorders and epilepsy

Behavior problems such as aggression, property destruction, stereotypy, self-injurious behavior, and other disruptive behavior are commonly observed among adults with intellectual disabilities (ID), autism spectrum disorders (ASD), and epilepsy residing at state-run facilities. However, it is unknown how these populations differ on behavior problem indicies. Assessment of behavior problems were made with the ASD–behavior problems-adult version battery. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups, Wilks's Λ = .79, F(12, 246) = 1.93, p < .05. The multivariate η² based on Wilks's Λ was .08. A one-way ANOVA was conducted for each of the four subscales of the ASD–BPA as follow-up tests to the MANOVA. Groups differed on the aggression/destruction subscale, F(3, 96) = .79, p > .05, η² = .03, and stereotypy subscale, F(3, 96) = 2.62, p > .05, η² = .08. No significant differences were found on the self-injury subscale and disruptive behavior subscale. Trend analysis demonstrated that individuals with ID expressing combined co-morbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single co-morbid factor with ID (ASD or epilepsy only) on these four subscales. Implications of these findings in the context of known issues in ID, epilepsy, and ASD, current assessment practices among these populations and associated challenges are discussed.     

Norms and cut off scores for the autism spectrum disorders diagnosis for adults (ASD-DA) with intellectual disability

Establishing the cut-off scores for Autism Spectrum Disorder-Diagnostic (ASD-DA) scale for adults with intellectual disability (ID) and autism or PDD-NOS was the primary goal of this investigation. The aim of Study 1 was to determine if the ASD-DA was able to differentiate between adults with ID with and without an autism spectrum disorder, and to determine a total score cut-off for this purpose. The aim of Study 2 was to determine if the ASD-DA was able to differentiate between autism and PDD-NOS in this population. Sensitivity, specificity, and receiver operating characteristics (ROC) were computed for potential cut-off scores and were found to be acceptable. The implications of these data for diagnosing ASD in adults with ID are discussed.     

The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder.

PURPOSE: The current paper focused on the validity of using self-reports to assess emotion regulation abilities in autism spectrum disorders (ASD). To assess this we sought responses to two alexithymia self-reports and a depression self-report at two time points from adults with and without ASD. MATERIALS AND METHODS: An initial sample of 27 adults with ASD and 35 normal adults completed the 20-item Toronto alexithymia scale (TAS-20), the Bermond and Vorst alexithymia questionnaire-form B (BVAQ-B), and the Beck depression inventory (BDI), at test time 1. Of these individuals, 19 ASD and 29 controls participated again after a period ranging from 4 to 12 months. RESULTS: ASD participants were able to report about their own emotions using self-reports. BVAQ-B showed reasonable convergent validity and test-retest reliability in both groups. Scores on both alexithymia scales were stable across the two participant groups. However, results revealed that although the TAS-20 total score discriminated between the two groups at both time points, the BVAQ-B total score did not. Moreover, the TAS-20 showed stronger test-retest reliability than the BVAQ-B. CONCLUSION: ASD participants appeared more depressed and more alexithymic than the controls. The use of the BVAQ-B, as an additional assessment of alexithymia, indicated that ASD patients have a specific type of alexithymia characterised by increased difficulties in the cognitive domain rather than the affective aspects of alexithymia.     

Teaching life skills to adults disabled by autism

The acquisition of life skills is a high priority for adults disabled by autism who are living in community-based residential programs. A training program was implemented and evaluated that consisted of analyzing life skills into component steps and providing increasing levels of assistance according to a predetermined schedule. Five adults who were severely disabled by autism and who lived in group homes in the community served as participants. All five adults showed progress in targeted life skills, and four of the five achieved independence on their targeted skills. The usefulness of this training model in community-based residential programs is discussed.Preparation of this article was supported in part by the United States Department of Education Grant G008430115, by the National Institute of Handicapped Research, Department of Education Grant G008435019, and by a Mary Switzer Fellowship from the National Institute of Handicapped Research. However, the opinions expressed herein do not necessarily reflect the position or policy of the U.S. Department of Education. The work presented in this article was conducted at Community Services for Autistic Adults and Children, 751 Twinbrook Parkway, Rockville, Maryland. We gratefully acknowledge Patricia Juhrs for her administrative support, Lydia Sporidis and Judy Lewis for their clerical assistance, Derek Berrian for preparing the figures, and Jack Smith for reviewing and editing the draft of this article.     

Sterilisation of intellectually disabled women.

OBJECTIVE: To point out the proportion of intellectually disabled women (IDW) who are sterilised, and the medical and social factors associated with an increased probability to be sterilised. STUDY DESIGN: A population-based study among 97% of IDW aged 18-46, attending government-accredited institutions in the region of Brussels-Capital and the province of Walloon Brabant (Belgium). RESULTS: Among the IDW included in this study, 22.2% are sterilised, which is superior to the 7% in the general Belgian population. Factors associated with an increased probability to be sterilised are: living in an institution, having a higher intellectual quotient (IQ), being enrolled in an institution where sexual intercourse is authorised and attending an institution where contraception is required. The last three factors are significant only among women living in institutions and the last two, only in women with severe disability. Among IDW using contraception, no factor was associated with a greater probability to be sterilised. CONCLUSION: The prevalence of sterilisation among IDW is three times higher than that in the Belgian population and it is mainly correlated with factors related to the institution where these women live, especially the severely disabled.     

A comparison of social skills profiles in intellectually disabled adults with and without ASD

The purpose of this study was to systematically examine the social-skills profiles among adults with autism spectrum disorders (ASD) and intellectual disability (ID). Using one-way multivariate analysis of variance (MANOVA), three groups (autism, pervasive developmental disorder-not otherwise specified [PDD-NOS], and ID only) were compared on seven global measures of social behavior. There were 72 individuals in each group matched on level of ID, verbal ability, age, and gender. Distinctions were noted in the areas of positive social behaviors and negative nonverbal social behaviors. Those with autism displayed the greatest deficits in these areas, followed by those with PDD-NOS. The results support the notions that social impairment remains a distinct feature of ASD in adults with ID, that autism and PDD-NOS are two conditions on the same spectrum, and that this spectrum is relevant for adults with ID. Implications of the results and directions for future research are discussed.     

Fitness to plead and the intellectually disabled offender

The doctrine of fitness to plead has early origins in the English common law. In order to avoid the indignity of trying a person before the person had pleaded to a charge, the common law developed bizarre and painful procedures to “encourage” an offender to plead and which enabled the courts to distinguish between persons who were constitutionally unable to plead and those who wilfully refused to do so. Important distinctions were made for this purpose between those who were intellectually disabled and those who were merely mentally ill, who might be expected to recover and be able to be tried. For the most part this distinction has been lost in modem statutory provisions dealing with fitness to plead. New Zealand provides a good example. In that jurisdiction, recent changes to mental health legislation have marginalised intellectually disabled offenders in relation to the determination of fitness to plead and law change is needed to deal with the anomalies that have arisen. Some proposals for such law change are discussed.     

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

BackgroundGroup social skills interventions (SSI) are partially effective for addressing the communication and social interaction impairments experienced by individuals with autism spectrum disorders (ASD). Social anxiety has been found to be a moderating mechanism for SSI in young people with ASD. Comparatively few studies have investigated the effectiveness of SSI in the adult ASD population, and none so far have investigated group approaches incorporating SSI and anxiety management techniques.MethodThe present study describes the design and evaluation of a non-randomised single-arm, 11 week group interaction anxiety and social skills intervention, piloted on three occasions during routine clinical practice at an adult ASD service. The intervention was informed by a cognitive behaviour therapy (CBT) framework. Eighteen cognitively-able adult males with ASD attended. Outcome measures were completed pre- and post-intervention.ResultsSelf-reported social anxiety improved (p = 0.01, d = 0.65). Low mood, general anxiety and functioning did not change significantly (p > 0.05, d < 0.20). Qualitative feedback indicated that participants found the intervention to be acceptable and useful for improving social knowledge and coping strategies, and reducing avoidance behaviours. Attrition was low (n = 2).ConclusionsThese results suggest that integrating SSI and anxiety management techniques in a group format is acceptable to adults with ASD, and can reduce symptoms of social anxiety. Whether SSI enhance social skills in adults requires further investigation. In clinical practice, consideration should be given to augmenting SSI with CBT techniques designed to target concurrent symptoms of social anxiety.     

Topiramate in long-term treatment of epilepsy in the intellectually disabled

Background To study the effectiveness of topiramate (TPM) in refractory epilepsy in patients who have intellectual disability (ID). Methods A representative population sample of 57 patients with ID (age range 2–61, mean 32.8) was administered add-on TPM for drug-refractory epilepsy. Results Seizure freedom for at least for 6 months was attained by 10 (17%), and seizure reduction of ≥ 50% by further 26 (46%). Less than 50% decrease in seizure frequency was found in 16 (29%). TPM was more efficacious in localisation-related than in generalised epilepsies (81% vs. 50%, P = 0.019). An at least 50% decrease in seizure frequency was achieved by patients with temporal lobe epilepsy in 100%, continuous spike–waves during sleep syndrome in 75%, Lennox–Gastaut syndrome in 52%, and those with infantile spasms in 25% of cases. As great decrease in seizure frequency was found in most patients with cortical dysplasia (83%), acquired encephalopathy with mesial temporal sclerosis (MTS) (75%), and genetic disease associated with MTS (66%). Adverse effects occurred in 10% including two (3%) with seizure aggravation and three (5%) necessitating discontinuation. Conclusion TPM is an effective antiepileptic drug which is of value in treating people with seizures that are resistant to other antiepileptic medication. As a broad-spectrum drug it may substitute for polypharmacy and, at the same time decrease adverse effects and costs of therapy.     

Diagnosing high incidence autism spectrum disorders in adults

Autism spectrum disorders (ASDs), particularly the high incidence conditions of autism, PDD NOS, and Asperger's Syndrome, have become increasingly popular topics of study in the mental health field. Traditionally, the focus has been on young children and early recognition and diagnosis. However, given that these conditions are life long in nature, continued assessment in not only advisable but essential. This review covers diagnostic issues as they pertain to adults with high incidence ASD. The current state of nosology and diagnosis in adults with ASD is reviewed. A discussion of pragmatic diagnostic issues and future research needs are covered.     

Work performance skills in adults with and without high functioning autism spectrum disorders (HFASD)

The Autism Work Skills Questionnaire (AWSQ) consists of 78 items, divided into 6 domains; 5 domains focus on employment skills, the 6th relates to one's sensory needs within the work environment. Initial internal consistency reliability for the AWSQ has been established. The purpose of this study was to examine its discriminate validity between people with HFASD to controls with Typical Development (TD). The AWSQ was completed by a convenience sample of 102 TD subjects (25 women, 77 men) and 37 subjects with HFASD (7 women, 30 men), both groups were aged 20–40. From the TD sample, 37 individuals were further matched to those with HFASD.Significant differences were found between the work skills of people with and without HFASD. Differences were found in almost all the domains of the AWSQ. Significant correlations were found between the different categories among people without HFASD as opposed to a small number of correlations among people with HFASD. These findings suggest a unique working profile among those with HFASD, in comparison to the TD sample, and highlight the importance of assessing their unique abilities and challenges in order to provide people with HFASD with a job that matches their interests and working profiles.     

Increased serum androstenedione in adults with autism spectrum conditions

Molecular and behavioural evidence points to an association between sex-steroid hormones and autism spectrum conditions (ASC) and/or autistic traits. Prenatal androgen levels are associated with autistic traits, and several genes involved in steroidogenesis are associated with autism, Asperger Syndrome and/or autistic traits. Furthermore, higher rates of androgen-related conditions (such as Polycystic Ovary Syndrome, hirsutism, acne and hormone-related cancers) are reported in women with autism spectrum conditions. A key question therefore is if serum levels of gonadal and adrenal sex-steroids (particularly testosterone, estradiol, dehydroepiandrosterone sulfate and androstenedione) are elevated in individuals with ASC. This was tested in a total sample of n=166 participants. The final eligible sample for hormone analysis comprised n=128 participants, n=58 of whom had a diagnosis of Asperger Syndrome or high functioning autism (33 males and 25 females) and n=70 of whom were age- and IQ-matched typical controls (39 males and 31 females). ASC diagnosis (without any interaction with sex) strongly predicted androstenedione levels (p<0.01), and serum androstenedione levels were significantly elevated in the ASC group (Mann-Whitney W=2677, p=0.002), a result confirmed by permutation testing in females (permutation-corrected p=0.02). This result is discussed in terms of androstenedione being the immediate precursor of, and being converted into, testosterone, dihydrotestosterone, or estrogens in hormone-sensitive tissues and organs.     

Biographical disruption: Experiences of mothers of adults assessed for autism spectrum disorder

ABSTRACT

Background Little is known about the experiences of parents whose sons or daughters are diagnosed with autism spectrum disorder (ASD) during adulthood.

Method In this exploratory study, 6 mothers of adults recently diagnosed with ASD were interviewed about the ASD assessment process. Thematic analysis was used to analyse the interviews.

Results Two superordinate themes are described: (1) biographical continuity, and (2) biographical disruption. Mothers did not experience significant disruption around the ASD assessment itself, as they had sought an explanation for their son’s/daughter’s behaviour since childhood. Therefore, being referred for an ASD assessment was simply another assessment for their son or daughter and was thus a biographical continuity. Mothers experienced biographical disruption once an ASD diagnosis was received, as they realised that an ASD diagnosis did not result in any additional support, and found this greatly frustrating.

Conclusions There is an unmet need for postdiagnostic support among adults diagnosed with ASD, and for their parents.     

Internet-delivered psychoeducation for older adolescents and young adults with autism spectrum disorder (SCOPE): An open feasibility study

BackgroundThere is a paucity regarding interventions in general, and especially internet-delivered treatment options, for adolescents and young adults with autism spectrum disorder (ASD), despite the group´s capacity and willingness to utilize computer-mediated communication. This open feasibility study evaluated the new internet-delivered, psychoeducational intervention, SCOPE (Spectrum COmputerized PsychoEducation), for adolescents and young adults aged 16–25 years with ASD in the normative IQ range.MethodThe participation in SCOPE was facilitated by weekly contacts with disability service professionals (trained coaches) and the intervention consisted of eight ASD-themed modules. In an open feasibility study we evaluated treatment completion, treatment credibility and satisfaction, as well as preliminary efficacy. We assessed feasibility in an outpatient disability services context, regarding both participants’ and coaches’ experiences.ResultsTwenty-three out of the 29 included participants (79%) completed the intervention. The participants’ experience of treatment credibility was increased during the SCOPE web course and the overall satisfaction with the treatment was high. The coaches reported high treatment credibility and good clinical feasibility of the internet-based delivered intervention. The participants’ knowledge of ASD increased significantly from pre-intervention to post-intervention. The increased knowledge of ASD was not associated with negative effects on psychological well-being.ConclusionsOur results suggest that the internet-delivered psychoeducational intervention SCOPE is a feasible intervention and could contribute to youth’s sense of empowerment through increased knowledge of ASD and themselves. An ongoing randomized controlled study will generate further evidence concerning the SCOPE intervention.     

Convergent validity of the Autism Spectrum Disorders-Diagnostic Adult (ASD-DA) with the Pervasive Developmental Disorder/Autism subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II)

The Autism Spectrum Disorders-Diagnosis for Adults (ASD-DA) is a standardized assessment used to measure autistic symptomatology in adults with intellectual disabilities (ID). In order to further establish the validity of this measure, convergent validity of the ASD-DA was established by comparing ASD-DA total and subscales scores with the Pervasive Developmental Disorder/Autism (PDD/Autism) subscale score on the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Data was collected from 278 adults residing in two large supports and services centers in the southeastern region of the United States. The ASD-DA total scores and all subscale scores correlated with the PDD/Autism subscale score at the p < .001 level, further supporting the validity of the ASD-DA as a valid measure of autistic symptoms in adults with ID. The implications of these findings are discussed.