Autism In Adults Research Articles

Autism diagnostic aid (ADA) tool for use in adults with intellectual disability: development, face and content validation

PurposeIndividuals with intellectual disability have an increased predisposition to other co-morbid physical health conditions, mental illness and neurodevelopmental conditions including autism spectrum condition. There are challenges in diagnosing autism in adults with intellectual disability, and these are often attributes to the complexities in symptoms. The purpose of this paper is to describe the development of the autism diagnostic aid (ADA) tool and face and content validation of its properties.Design/methodology/approachThe ADA tool was developed following a detailed scoping exercise which included literature reviews, observations and discussion with wider multi-disciplinary team members. A face and content validation after consultation with eight experts who are trained and routinely perform assessments for autism spectrum disorders. The experts also have expertise in working with individuals with intellectual disability.FindingsThe experts agreed that the ADA tool is appropriate to the targeted construct and assessment objectives as a diagnostic aid in the assessment of autism in adults with intellectual disability. They also determined that the content of ADA tool was valid for its use as a diagnostic aid in the diagnosis of adults with intellectual disability.Research limitations/implicationsThe ADA tool was considered a valid tool from the expert’s perspective. It was identified to have a good face and content validity. To the best of the authors’ knowledge, the ADA is first of its kind tool, developed specifically to aid clinicians with autism assessments in adults with intellectual disability.Practical implicationsThis tool could potentially help with timely assessment and help with providing appropriate intervention but would require further exploration.Originality/valueTo the best of the authors’ knowledge, this is the first of its kind tool for the assessment of autism in adults with intellectual disability.

Co-occurring autism, ADHD, and gender dysphoria in children, adolescents, and young adults with eating disorders: an examination of pre- vs. post-COVID pandemic outbreak trends with real-time electronic health record data.

Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data. To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic. We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person's index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient's first ED diagnosis. We applied propensity score-matched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022. Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95%CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort. Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the pre-pandemic 2017-2019 cohort, even after controlling for baseline levels of co-occurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults.

AUTISM IN ADULTS: Feelings and changes after a late diagnosis

Previously considered a rare childhood disorder, autism today is a frequent diagnosis with increasing demand in all age groups, including people who were not diagnosed in childhood, but who perceive characteristics of this condition. This study, which is part of a broader research on the experience of Brazilian adults who were diagnosed with autism spectrum disorder (ASD) after 18 years, aims to explore the feelings and life changes of this group of people after the diagnosis. To this end, a qualitative research was carried out in which 12 participants were interviewed and the data were analyzed using the content analysis method, in its categorical aspect. Considering the objective of this work, in the analysis of the interviews, these categories emerged: alexithymia, relif, revisiting the past, self-compassion and acquired rights. As a result, relief was observed as a feeling of great relevance and predominance, accompanied by a process of understanding the past and self-compassion and self-respect. It was concluded that the late receipt of the diagnosis of autism by this group of participants allowed a better understanding of their characteristics and behaviors, reducing the pressure they exerted on themselves, in addition to enabling access to rights guaranteed by law.

Autism Among Adults with Down Syndrome: Prevalence, Medicaid Usage, and Co-Occurring Conditions.

Our objective was to examine occurrence of both conditions in Medicaid; and compare Medicaid service use and cost, and chronic conditions among adults with Down syndrome and autism to those with Down syndrome alone and those with autism alone. We used ICD9 and ICD10 codes in Medicaid claims and encounters from 2011 to 2019 to identify autism and Down syndrome in adults > 18 years. We then calculated costs, claims, hospitalizations, long term care days, and chronic conditions, and compared by group- autism alone, Down syndrome alone, Down syndrome + autism. Between 2011 and 2019, there were 519,450 adult Medicaid enrollees who met our criteria for autism (N = 396,426), Down syndrome (N = 116,422), or both Down syndrome and autism (N = 6,602). In 2011, 4.1% of enrollees with Down syndrome had co-occurring autism; by 2011 it was 6.6%. The autism group had the fewest claims and inpatient hospitalizations, followed by the Down syndrome group, then the Down syndrome + autism group. After age adjustment, those with Down syndrome alone and Down syndrome + autism had elevated prevalence of atrial fibrillation, dementia, heart failure, kidney disease, and obesity compared to the autism alone group. Both groups also had decreased occurrence of depression and hypertension compared to the autism alone group. Prevalence of autism is higher among people with Down syndrome than in peers. The increased costs and service use for those with both conditions highlight the extent to which this population need health care and signal the need for more effective preventative care and therapies.

Protocol for a systematic review evaluating psychometric properties and gender-related measurement (non)invariance of self-report assessment tools for autism in adults

BackgroundGiven the recent evidence on gender differences in the presentation of autism, there is an increasing concern that current tools for autism do not adequately capture traits more often found in women. If tools for autism measure autistic traits differently based on gender alone, their validity may be compromised as they may not be measuring the same construct across genders. Measurement invariance investigations of autism measures can help assess the validity of autism constructs for different genders. The aim of this systematic review is to identify and critically appraise the psychometric properties of all self-report tools for autism in adults that meet two criteria: (a) they have been published since or included in the NICE (2014) recommendations, and (b) they have undergone gender-related measurement invariance investigations as part of their validation process.MethodsA search of electronic databases will be conducted from 2014 until the present using MEDLINE, Embase, and PsycINFO using predefined search terms to identify eligible studies. The search for grey literature will include sources such as OpenGrey, APA PsycEXTRA, and Scopus. Two reviewers will independently screen titles, abstracts, and full texts for eligibility. The references of included studies will be searched for additional records. The methodological quality of the studies will be evaluated using the COSMIN Risk of Bias checklist, while psychometric quality of findings will be assessed based on criteria for good measurement properties and ConPsy checklist. The quality of the total body of evidence will be appraised using the approach outlined in the modified GRADE guidelines.DiscussionThis systematic review will be among the first to assess the psychometric properties and gender-related measurement invariance of self-reported measures for autism in adults that were published since (or included in) NICE (2014) guidelines. The review will provide recommendations for the most suitable tool to assess for autism without gender bias. If no such measure is found, it will identify existing tools with promising psychometric properties that require further testing, or suggest developing a new measure.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42023429350.

Diagnosing Autism in Adults: Clinically Focused Recommendations

Diagnosing Autism in Adults: Clinically Focused Recommendations

A clinical decision support system using rough set theory and machine learning for disease prediction

ObjectiveTechnological advances have led to drastic changes in daily life, and particularly healthcare, while traditional diagnosis methods are being replaced by technology-oriented models and paper-based patient healthcare records with digital files. Using the latest technology and data mining techniques, we aimed to develop an automated clinical decision support system (CDSS), to improve patient prognoses and healthcare delivery. Our proposed approach placed a strong emphasis on improvements that meet patient, parent, and physician expectations. We developed a flexible framework to identify hepatitis, dermatological conditions, hepatic disease, and autism in adults and provide results to patients as recommendations. The novelty of this CDSS lies in its integration of rough set theory (RST) and machine learning (ML) techniques to improve clinical decision-making accuracy and effectiveness. MethodsData were collected through various web-based resources. Standard preprocessing techniques were applied to encode categorical features, conduct min-max scaling, and remove null and duplicate entries. The most prevalent feature in the class and standard deviation were used to fill missing categorical and continuous feature values, respectively. A rough set approach was applied as feature selection, to remove highly redundant and irrelevant elements. Then, various ML techniques, including K nearest neighbors (KNN), linear support vector machine (LSVM), radial basis function support vector machine (RBF SVM), decision tree (DT), random forest (RF), and Naive Bayes (NB), were employed to analyze four publicly available benchmark medical datasets of different types from the UCI repository and Kaggle. The model was implemented in Python, and various validity metrics, including precision, recall, F1-score, and root mean square error (RMSE), applied to measure its performance. ResultsFeatures were selected using an RST approach and examined by RF analysis and important features of hepatitis, dermatology conditions, hepatic disease, and autism determined by RST and RF exhibited 92.85 %, 90.90 %, 100 %, and 80 % similarity, respectively. Selected features were stored as electronic health records and various ML classifiers, such as KNN, LSVM, RBF SVM, DT, RF, and NB, applied to classify patients with hepatitis, dermatology conditions, hepatic disease, and autism. In the last phase, the performance of proposed classifiers was compared with that of existing state-of-the-art methods, using various validity measures. RF was found to be the best approach for adult screening of: hepatitis with accuracy 88.66 %, precision 74.46 %, recall 75.17 %, F1-score 74.81 %, and RMSE value 0.244; dermatology conditions with accuracy 97.29 %, precision 96.96 %, recall 96.96 %, F1-score 96.96 %, and RMSE value, 0.173; hepatic disease, with accuracy 91.58 %, precision 81.76 %, recall 81.82 %, F1-Score 81.79 %, and RMSE value 0.193; and autism, with accuracy 100 %, precision 100 %, recall 100 %, F1-score 100 %, and RMSE value 0.064. ConclusionThe overall performance of our proposed framework may suggest that it could assist medical experts in more accurately identifying and diagnosing patients with hepatitis, dermatology conditions, hepatic disease, and autism.

Unpacking the overlap between Autism and ADHD in adults: A multi-method approach

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their cross-condition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults – including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000) – completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research.

Executive function in schizophrenia and autism in adults shares common components separating high and low performance groups.

The profile of executive function (EF) in adults with Schizophrenia (SCZ) and autism spectrum disorder (ASD) remains unclear. This study aims to ascertain if distinct EF patterns can be identified between each clinical condition by comparing the neuropsychological profile of adults with SCZ and ASD, for whom the differential diagnosis is still highly challenging. Forty-five individuals (15 SCZ, 15 ASD, 15 controls) matched for age, sex, education level, and handedness underwent intelligence evaluation and neuropsychological testing for working memory, inhibition, planning and set-shifting, and verbal fluency subdomains. Principal component analysis (2D-PCA) using variables representing 4 domains was employed to identify patterns in neuropsychological profiles. The ASD group had lower scores on the Digits Forward subtest compared to the SCZ group (7.2 ± 2.1 vs. 9.3 ± 1.9, p = 0.003; Cohen's d: 1.05). ASD also performed significantly worse on the Stroop Word Test compared to the control group (77.7± 17.9 vs. 98.0 ± 12.7, p = 0.009; Cohen's d: 1.31). No significant differences were observed between ASD and SCZ on other EF measures. The larger contributors for the dimensions in 2D-PCA were the Digits Forward subtest and Stroop Word Test. Still, there was substantial overlap between the clinical groups. This study suggests a high degree of similarity of EF between SCZ and ASD. Through four EF measures, the discrimination of low and high-functioning EF groups spanning both diagnostic categories may help to identify the individuals who could better benefit from cognitive rehabilitation strategies.

Providing effective care and support for autistic adults with mental health issues.

Autism is a neurodevelopmental condition that is characterised by features such as persistent differences in social interaction and communication, specialised interests and sensory processing issues. It has been identified that autistic people are increasingly likely to experience various mental health issues, and often encounter challenges in accessing appropriate healthcare and a lack of understanding from healthcare professionals. This article explores the co-occurrence of autism and mental health issues in adults, and explains the role of nurses in providing care and support for this population.

FRI046 Clinical Phenotyping Of Adults With Genetic Obesity

Abstract Disclosure: M.S. Welling: None. M. Mohseni: None. R.E. Meeusen: None. M.R. Boon: None. C.J. de Groot: None. M.M. van Haelst: None. J.A. Visser: None. E.L. van den Akker: None. E.F. van Rossum: None. Introduction: In rare cases of obesity, genetic defects lead to hyperphagia and severe early-onset obesity. Genetic testing in patients with a suspected genetic obesity phenotype is important, as it can lead to patient-tailored treatment advice. For children, the Endocrine Society (ES) recommends genetic testing in children with early-onset of obesity (<5 years) and hyperphagia. It is unclear whether these recommendations can also be used in adult obesity care. Therefore, we aimed to phenotype adult patients with genetic obesity disorders. In addition, we assessed the suitability of the pediatric ES recommendations in these patients. Methods: We analyzed clinical data of patients with non-syndromic genetic obesity (NSO) and syndromic genetic obesity (SO), who visited our academic obesity center (Erasmus Medical Center, Rotterdam, the Netherlands). A standardized medical questionnaire, including topics concerning e.g. age of onset of obesity, hunger and satiation, was assessed. Anthropometrics, body composition (bio-impedance analysis), and resting energy expenditure (REE, indirect calorimetry) were measured. Differences between the NSO and SO groups were studied. Results: Sixty-six patients, of which n=26 with NSO and n=40 with SO, were included: median BMI and age at intake were 41.2 vs 39.2 kg/m2 and 25.7 vs 24.8 yrs, respectively (ns). The median age of onset of obesity was 2.5 [1-5] yrs in NSO and 9.5 [4-14] yrs in SO (p<0.001). Impaired appetite regulation was present in both groups: increased feelings of hunger in 64.0 vs 51.3% and impaired satiation in 47.1 vs 32.0% in NSO vs SO (ns). Binge eating was reported in 63.2% of SO, compared to 40.0% in NSO (p=0.071). The pediatric ES recommendations were fulfilled in 57.5% of NSO and 27.5% of SO (p=0.014). Compared to NSO, SO had a higher prevalence of intellectual deficit (3.8 vs 55.0%, p<0.001), autism (7.7 vs 26.3%, p=0.061) and retinal problems (0 vs 20.0%, p=0.015). There were no differences in body composition or REE. Conclusion: We report distinct phenotypic features concerning the age of onset of obesity, appetite regulation, and the presence of intellectual deficit, autism and retinal problems in adults with non-syndromic genetic obesity or syndromic genetic obesity. Additionally, this study demonstrates that the Endocrine Society’s recommendations for genetic testing in children with obesity, do not suit well for adults with obesity. Recommendations for genetic testing in adults with obesity are needed. Presentation: Friday, June 16, 2023

How Well Can we Diagnose Autism in Adults? Evaluating an Informant-based Interview: The Dutch Developmental, Dimensional and Diagnostic Interview – Adult Version (3Di-Adult)

The current study evaluated a brief, informant-based autism interview: the Developmental, Dimensional and Diagnostic Interview – Adult Version (3Di-Adult). Feasibility, reliability and validity of the Dutch 3Di-Adult was tested amongst autistic participants (n = 62) and a non-autistic comparison group (n = 30) in the Netherlands. The 3Di-Adult consists of two scales based on DSM-5 criteria: A scale ‘Social communication and social interaction’ and B scale ‘Restricted, repetitive patterns of behavior, interests or activities’. ROC curves were used to determine cut-off scores for the A and the B scale, using an ASD diagnosis made by an independent clinician as the criterion. Mean administration time was 42 min. Internal consistency of the A scale (α = 0.92) and the B scale (α = 0.85) were good. Inter-rater reliability (ICCs = 0.99) and inter-rater agreement (ICCs ≥ 0.90) were promising. The 3Di-Adult showed good sensitivity (80.6%) and specificity (93.3%). Positive and negative predictive value were 96.2% and 70.0% respectively. Comparisons with the Autism-Spectrum Quotient-Short to investigate the convergent validity showed moderate, significant correlations with the 3Di-Adult in the total sample. Males, as compared to females, displayed significantly more autistic features on the 3Di-Adult. No relationship was found of the 3Di-Adult with education level, intelligence and age of the participants or informants. The feasibility and psychometric properties of the Dutch 3Di-Adult are promising, indicating that it can be a time-efficient, valid and reliable tool to use in diagnosing autism in adults according to DSM-5 criteria.

Service evaluation project: Evaluating and addressing staff training needs in relation to autism in an older adult mental health service

Autistic adults are at higher risk of experiencing mental health problems and commonly describe poor service experiences relating to a lack of understanding of autism by clinicians. Therefore, there is an increasing impetus in the National Health Service (NHS) for staff to receive autism training. However, there is a lack of understanding around training needs for older adult mental health teams. This service evaluation project used audit and survey methodologies to explore the autism training needs of an older adult mental health team. Whilst the audit identified that the team did see patients suspected to be on the autism spectrum, most patients did not have an official diagnosis. Most clinicians reported never having received any training in autism, and highlighted autism in older adults, and autism and mental health, as specific training priorities. A training programme based on these responses was developed, implemented, and evaluated using surveys. The training was rated as useful by attendees and resulted in non-statistically significant increases in self-rated knowledge. The findings of this study suggest that clinicians working in older adult mental health may particularly benefit from training specialised to their older adult context. Further research is required to better understand the area of older adulthood and autism, and to evaluate how to effectively enhance the capability of staff working in this area.

Age-related physical health of older autistic adults in Sweden: a longitudinal, retrospective, population-based cohort study

Research of health outcomes in older autistic adults (≥45 years) is concerningly scarce, and little is known about whether intellectual disability and sex affect the health outcomes of this population. The aim of this study was to investigate the association between autism and physical health conditions in older adults and to examine these associations by intellectual disability and sex. We conducted a longitudinal, retrospective, population-based cohort study of the Swedish population born between Jan 1, 1932, and Dec 31, 1967, using linked data from the nationwide Total Population Register and the National Patient Register. We excluded individuals who died or emigrated before the age of 45 years, or with any chromosomal abnormalities. Follow-up started at age 45 years for all individuals, and ended at emigration, death, or Dec 31, 2013 (the latest date of available follow-up), whichever was soonest. Diagnoses of autism, intellectual disability, 39 age-related physical conditions, and five types of injury (outcomes) were obtained from the National Patient Register. For each outcome, we calculated 25-year cumulative incidence and used Cox models to estimate hazard ratios (HRs). All analyses were repeated separately by intellectual disability and sex. Of 4 200 887 older adults (2 063 718 women [49·1%] and 2 137 169 men [50·9%]) in the study cohort, 5291 (0·1%) had a diagnosis of autism recorded in the National Patient Register. Older autistic adults (median follow-up 8·4 years [IQR 4·2-14·6]) had higher cumulative incidence and HRs of various physical conditions and injuries than their non-autistic counterparts (median follow-up 16·4 years [8·2-24·4]). In autistic individuals, the highest cumulative incidence was observed for bodily injuries (50·0% [95% CI 47·6-52·4]). Conditions that autistic adults were at higher risk of than were non-autistic adults included heart failure (HR 1·89 [95% CI 1·61-2·22]), cystitis (2·03 [1·66-2·49]), glucose dysregulation (2·96 [2·04-4·29]), iron deficiency anaemia (3·12 [2·65-3·68]), poisoning (4·63 [4·13-5·18]), and self-harm (7·08 [6·24-8·03]). These increased risks mainly persisted regardless of intellectual disability or sex. Our data indicate that older autistic adults are at substantially increased risk of age-related physical conditions and injuries compared with non-autistic adults. These findings highlight the need for collaborative efforts from researchers, health services, and policy makers to provide older autistic individuals with the necessary support to attain healthy longevity and a high quality of life. Swedish Research Council, Servier Affaires Medicales. For the Swedish translation of the abstract see Supplementary Materials section.

Autism diagnosis in females by eating disorder professionals

ImportanceAutism and eating disorders cooccur at high rates, with autism impacting the efficacy of eating disorder treatments and outcomes. Females are underdiagnosed with autism and diagnosed later in life than their male counterparts.ObjectiveThe purpose of this study was to define the incidence of eating disorder professionals identifying autism in female adolescents and young adults engaged in treatment for an eating disorder.DesignThe research design is a cross-sectional retrospective records review. The charts reviewed were from the medical records of forty assigned-at-birth females between the ages of 13–25 who received treatment for an eating disorder at the partial hospitalization program (PHP) level of care between 2020 and 2022.Main outcomesUpon entering PHP for an eating disorder, 10% of the study participants had a pre-existing diagnosis of autism. A total of 27.5% of participants had clinical suspicion of autism. The number of autism traits that an individual possessed directly correlated with the number of calendar days in treatment.ConclusionEating disorder professionals in this study identified autism in 17.5% of adolescent and young adult females who entered PHP treatment for an eating disorder who had not previously been diagnosed with autism. Eating disorder professionals can anticipate that individuals with autism may be in treatment for a longer duration. Further studies should explore effective treatment measures for those with autism in treatment for an eating disorder.

Autism Spectrum Disorder

Adults have a significantly harder time being diagnosed with autism, and this is due to many reasons, such as the paucity of information about adults with autism, their diagnosis being missed as a child, lack of providers who feel confident in their knowledge to diagnose autism in adults, and an autistic adult’s ability to mask and cope in a neurotypical world since childhood, among others. Few tests are available and specifically target adult diagnosis. Most tests are created for children or youth and may not account for the difference in the presentation of autism in adults and the coping skills and masking they have required to develop throughout their lives. This paper talks about the need for adequate knowledge and testing for autism in the adult population.

Intellectual disability and autism in adults influence psychological treatments for mental health comorbidities

PurposeThe purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services.Design/methodology/approachA cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.FindingsThere was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses.Research limitations/implicationsNot having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism.Originality/valueThis large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

Understanding the Self-identification of Autism in Adults: a Scoping Review

AbstractAdults are increasingly self-identifying as autistic, and reporting problems being referred for an autism diagnostic assessment. This scoping review aims to ascertain: (1) what research has been conducted on the self-identification process of autism in adults, who do and do not have a formal diagnosis of autism, and (2) which aspects of the self-identification process could be used to improve the referral and the diagnostic process of an adult autism assessment. The main themes identified were: the diagnostic process from a client´s perspective; the process of self-identifying as autistic from a lifespan perspective; an autistic identity; sexual identity and experiences, and the perception of autism as a difference or a disability. These themes could positively enhance the referral and diagnostic process.

Effects of data preprocessing on detecting autism in adults using web-based eye-tracking data

ABSTRACT Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, often associated with social and communication challenges and whose prevalence has increased significantly over the past two decades. The variety of different manifestations of ASD makes the condition difficult to diagnose, especially in the case of highly independent adults. A large body of work is dedicated to developing new and improved diagnostic techniques, emphasising approaches that rely on objective markers. One such paradigm is investigating eye-tracking data as a promising and objective method to capture attention-related differences between people with and without autism. This study builds upon prior work in this area that focussed on developing a machine-learning classifier trained on gaze data from web-related tasks to detect ASD in adults. Using the same data, we show that a new data pre-processing approach, combined with an exploration of the performance of different classification algorithms, leads to an increased classification accuracy compared to prior work. The proposed approach to data pre-processing is stimulus-independent, suggesting that the improvements in performance shown in these experiments can potentially generalise over other studies that use eye-tracking data for predictive purposes.

The Autism-Spectrum Quotient-Hebrew version: Psychometric properties of a full and a short form, adapted for DSM-5.

Despite the attempt to diagnose autism at an early age, there are still many individuals who would only get an autism diagnosis in adulthood. For these adults, a questionnaire that could assist in highlighting their need to seek diagnostic assessment is needed. The Autism-Spectrum Quotient is a self-report scale used to assess autistic traits. It was tested cross-culturally, and a short version was recommended to help identify adults who should be referred for an autism assessment. However, its relevance for the up-to-date diagnostic criteria, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), has not been tested. This study aimed to examine the psychometric properties of the Hebrew version of the Autism-Spectrum Quotient and to create a short version of the Hebrew Autism-Spectrum Quotient, based on items which map on to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Ninety-three autistic adults (24 females), aged 18-51, clinically diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and 147 comparable controls (34 females) filled out the Hebrew version of the Autism-Spectrum Quotient. Ten clinicians who specialize in diagnosing autism in adults classified the Autism-Spectrum Quotient's items according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. The short version of the Hebrew Autism-Spectrum Quotient comprised items that best differentiated between adults with and without autism, five items representing each of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic domains. The overall probability for participants to be correctly classified as autistic or neurotypical was 86% for the Hebrew version of the Autism-Spectrum Quotient and 88% for the short version of the Hebrew Autism-Spectrum Quotient. We conclude that both versions are reliable and sensitive instruments that can help referring adults for autism assessment.