Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-25T23:25:32.400Z Has data issue: false hasContentIssue false

Autistic spectrum disorder without intellectual impairment in adult mental health services – fostering new perspectives and enhancing existing services

Published online by Cambridge University Press:  09 October 2018

N. Crowley*
Affiliation:
Psychology, HSE Dublin Mid Leinster, Bridge Street, Portlaoise, Laois, Tullamore R32 D525, Ireland
H. O’Connell
Affiliation:
Psychology, HSE Dublin Mid Leinster, Bridge Street, Portlaoise, Laois, Tullamore R32 D525, Ireland
M. Gervin
Affiliation:
Psychology, HSE Dublin Mid Leinster, Bridge Street, Portlaoise, Laois, Tullamore R32 D525, Ireland
*
*Address for correspondence: N. Crowley, Psychology, HSE Dublin Mid Leinster, Bridge Street, Portlaoise, Laois, Tullamore, Ireland (Email: niall.crowley@hse.ie)

Abstract

Autistic spectrum disorder (ASD) is a neuro-developmental disability with multi-systemic impacts. Individuals with ASD without intellectual impairment (DSM-V) or Aspergers (DSM-IV) are often particularly vulnerable to mental health problems such as anxiety disorders including social phobia and generalised anxiety disorder, depressive disorders and psychosis. Adults with ASD without intellectual impairment suffer higher rates of physical and psychiatric morbidity, display a poorer ability to engage with treatment and have a lower chance of recovery compared with the general population. It is widely acknowledged that adults with suspected ASD without intellectual impairment and co-morbid mental health problems are often not best supported through adult mental health services and often require more tailored supports. This review seeks to (a) increase awareness in the area of undiagnosed cases of ASD without intellectual impairment in adult mental health settings and (b) highlights the importance of identifying this population more efficiently by referring to best practice guidelines. The value of future research to examine the benefit of having a team of specialist staff within adult mental health teams who have received ASD training and who are supported to work with the ‘core difficulties’ of ASD is discussed and a model for the same is proposed. It is proposed that a specialist team could form a ‘hub’ for the development of expertise in ASD, which when adequately resourced and funded could reach across an entire region, offering consultancy and diagnostic assessments and interventions.

Type
Perspective Piece
Copyright
© College of Psychiatrists of Ireland 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Baio, J, Wiggins, L, Christensen, DL, Maenner, MJ, Daniels, J, Warren, Z, Kurzius-Spencer, M, Zahorodny, W, Robinson, Rosenberg C, White, T, Durkin, MS, Imm, P, Nikolaou, L, Yeargin-Allsopp, M, Lee, LC, Harrington, R, Lopez, M, Fitzgerald, RT, Hewitt, A, Pettygrove, S, Constantino, JN, Vehorn, A, Shenouda, J, Hall-Lande, J, Van Naarden Braun, K, Dowling, NF (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ, 67, 123.CrossRefGoogle Scholar
Binnie, J, Blainey, S (2013). The use of cognitive behavioural therapy for adults with autism spectrum disorders: a review of the evidence. Mental Health Review Journal 18, 93104.CrossRefGoogle Scholar
Bishop-Fitzpatrick, L, Minshew, NJ, Eack, SM (2013). A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism Development Disorders 43, 687694.CrossRefGoogle ScholarPubMed
British Columbia Ministry of Health Planning (2003). Standards and Guidelines for the Assessment and Diagnosis of Young Children with Autism Spectrum Disorder in British Columbia: An Evidenced-Based Report. Canada.Google Scholar
Department of Education and Science (2001). The Report of the Task Force on Autism: Educational Provision and Support for Persons With Autistic Spectrum Disorders. Stationary Office: Dublin. (https://www.sess.ie/sites/default/files/Autism%20Task%20Force%20Report.pdf).Google Scholar
Expert Group on Mental Health Policy (2006). Vision for Change. Stationary Office: Dublin.Google Scholar
Fitzgerald, M (2012). Schizophrenia and autism/asperger’s syndrome: overlap and difference. Clinical Neuropsychiatry 9, 171176. Google Scholar
Gillberg, IC, Gillberg, C (1989). Asperger syndrome–some epidemiological considerations: a research note. Journal of child psychology and psychiatry 30, 631638.CrossRefGoogle Scholar
Kočovská, E, Biskupstø, R, Carina Gillberg, I, Ellefsen, A, Kampmann, H, Stórá, T, Billstedt, E, Gillberg, C (2012). The rising prevalence of autism: a prospective longitudinal study in the Faroe Islands. Journal of autism and developmental disorders 42, 19591966.CrossRefGoogle Scholar
Kiyoharu, T, Tsuyoshi, K (2014). Autism spectrum disorder among first-visit depressed adult patients: diagnostic clues from backgrounds and past history. General Hospital Psychiatry 36, 737742.Google Scholar
Lehnhardt, FG, Gawronski, A, Volpert, K, Schilbach, L, Tepest, R, Vogeley, K (2012). Psychosocial functioning of adults with late diagnosed autism spectrum disorders–a retrospective study. Fortschritte der Neurologie-Psychiatrie 80, 8897.CrossRefGoogle ScholarPubMed
Moseley, DS, Tonge, BJ, Brereton, AV, Einfeld, SL (2011). Psychiatric comorbidity in adolescents and young adults with autism. Journal of Mental Health Research in Intellectual Disabililities 4, 229243.CrossRefGoogle Scholar
National Autistic Society (2003). National Autistic Plan for Children (NAPC): Plan for the Identification, Assessment, Diagnosis and Access to Early Intervention For Pre-School and Primary School Aged Children With Autism Spectrum Disorders (ASD). The National Autistic Society: London.Google Scholar
National Autism Services Review Group (2012). National Review of Autism Services Past, Present and Way Forward. (https://www.hse.ie/eng/services/publications/Disability/autismreview2012.pdf). Accessed 17 June 2016.Google Scholar
National Council Special Education (2016). An evaluation of education provision for students with autism spectrum disorder in Ireland. (http://ncse.ie/wp-content/uploads/2016/07/5_NCSE-Education-Provision-ASD-Students-No21.pdf).Google Scholar
National Institute for Health and Clinical Excellence (2012). Autism spectrum in adults: diagnosis and management. NICE guideline (CG142).Google Scholar
O’Rourke, L (2016). Psychiatric and physical comorbidity in adults with autism spectrum disorder. Unpublished MD Thesis. Dublin: Royal College of Surgeons in Ireland.Google Scholar
Russell, AJ (2016). The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: a clinic report. Autism 20, 623627.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (SIGN) (2016). Assessment, diagnosis and interventions for autism spectrum disorders. SIGN: Edinburgh (SIGN publication no. 145). (http://www.sign.ac.uk/assets/sign145.pdf). Accessed 17 June 2016.Google Scholar
Tantam, D, Prestwood, S (1999). A Mind of One’s Own: A Guide to the Specific Difficulties And Needs Of The More Able Person With Autism Or Asperger Syndrome, 3 rd edn. National Autistic Society: London.Google Scholar
Taylor, JL, McPheeters, ML, Sathe, NA, Dove, D, Veenstra-Vanderweele, J, Warren, Z (2012). A systematic review of vocational interventions for young adults with autism spectrum disorders. Pediatrics 130, 531538.CrossRefGoogle ScholarPubMed
The Psychological Society of Ireland Autism Spectrum Disorders Special Interest Group (2010). Best Practice Guidelines for the Assessment and Diagnosis of Autistic Spectrum Disorders for children and adolescents (birth to 18 years). The Psychological Society of Ireland. (http://www.psihq.ie/ page/file_dwn/102/Autism%20Spectrum%20Disorders%20-%20 Best%20Practice%20Guidelines.pdf). Accessed 23 May 2016.Google Scholar
Walters, S, Loades, M, Russell, A. (2016). A systematic review of effective modifications to cognitive behavioural therapy for young people with autism spectrum disorders. Review Journal of Autism and Developmental Disorders 3, 137153.CrossRefGoogle Scholar
White, SW, Ollendick, TH, Bray, BC (2011). College students on the autism spectrum: prevalence and associated problems. Autism 15, 683701.CrossRefGoogle ScholarPubMed
Wing, L, Gould, L (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of autism and developmental disorders 9, 1129.CrossRefGoogle Scholar
Wong, C, Odom, SL, Hume, KA, Cox, AW, Fettig, A, Kucharczyk, S, Brock, ME, Plavnick, JB, Fleury, VP, Schultz, TR (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: a comprehensive review. Journal of Autism and Developmental Disorders 45, 19511966.Google Scholar