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This paper aims to describe the way in which autism spectrum disorder (ASD) is identified, defined and diagnosed; and how changes in the conceptualisation and understanding of autism have impacted on clinical practice and research findings. Specific issues relating to the nature of Asperger syndrome and the profile of females with ASD are discussed. Finally, the apparent increase over time in the incidence of autism is considered.

The paper is a non‐systematic review of the current literature relating to the diagnosis and epidemiology of autism.

Despite its diverse presentation and complex aetiology, the autism spectrum is increasingly well understood amongst professionals and the general public. Diagnostic criteria are revised periodically and new versions of the formal definitions are due to be published soon. The prevalence of ASD appears to be in the region of 1 per cent. There is a clear perception that the true incidence of autism is on the increase and, despite several well‐conducted epidemiological studies, it remains impossible to confirm or refute this notion.

Diagnosis in clinical practice should involve some reference to the formal criteria, the use of standardised diagnostic instruments and should ideally take place within a multi‐disciplinary team setting.

This paper provides an up‐to‐date review of current diagnostic practice for all professionals working with children and adults with ASD.

This paper provides an historical perspective on dual diagnosis and current developments in the delivery of mental health and addiction services to people with dual diagnosis in Ireland. In light of government policy, it describes attempts made to improve the standards of care provided, recognising deficits in services, and not just those services provided to clients with a dual diagnosis. It identifies a number of issues that need to be addressed, including training, research, service developments, co‐operation between different service providers, information availability and measurement of client outcomes. It concludes that, although there is increasing awareness of the issue of dual diagnosis, this has not resulted in significant relevant policy implementation and improvements in services provided to clients with a dual diagnosis. Yet there is sufficient evidence available for a meaningful response to dual diagnosis, given the state of play in policy and service delivery in those settings with which people with dual diagnosis engage.

In this book it was proposed that autistic females and African American autistics are usually not participants in autistic research because they rarely receive an autism diagnosis. If diagnostic services were made more congenial for autistics from these groups, then the prospect of them being diagnosed as autistic and being available to be research participants would increase. To help achieve this outcome, this chapter begins by presenting some typical barriers that autistics encounter when trying to access autism diagnostic services. This is followed by an explanation of some consequences of this exclusion for autistics, their families and the research community. In an attempt to mitigate these consequences, and to increase the pool of potential autistic candidates for research, this chapter concludes with a series of suggestions to improve the public's accessibility to autism diagnostic services as well as suggestions for improving the autism diagnostic process for both children and adults.

The contribution that this chapter makes to the field of autism spectrum research is to provide clinicians with some important concepts that will help autistics feel valued and accepted during the diagnostic process. A potential flow-on effect of this knowledge is that more autistics who have experienced feeling valued and accepted by clinicians will be more inclined to be involved in research.

Dementia is a condition that involves inevitably progressive deficits in numerous cognitive domains, including thought, language, memory, understanding and judgement. A difference in behaviour may be noted, as well as overall loss of skills. Dementia is more than four times as prevalent in people with intellectual disabilities as in the general population. Diagnosis of the condition in people with intellectual disabilities, however, is often difficult due to lack of baseline skill assessment, high staff turnover in supported accommodation and low expectations of capabilities. Current National Institute for Health and Clinical Excellence (NICE) guidelines on anti‐dementia medication state that treatment should not be initiated until the condition has reached moderate severity. Determining whether symptoms are at this stage in people with intellectual disabilities is difficult because their skill level is already impaired. An accurate and extensive record of baseline skill levels in people with intellectual disabilities is therefore crucial, and regular comparison with baseline is key to early diagnosis of dementia.

The provision of a seamless service to address the needs of older people with substance misuse is now more pressing than ever, particularly given the impact of a growing population of older people in society, and with co‐morbid mental health and substance use issues. There is growing recognition of the public health needs of older people with mental health problems and substance misuse. This paper seeks to consider the development and implementation of one particular dual diagnosis strategy.

The paper examines the background, development and implementation of a dual diagnosis strategy designed to address the growing problem of substance misuse of older people in an inner city area in London, UK.

A needs assessment highlighted workforce training needs which led to the commissioning of innovative training to address this. Pathways were created to allow seamless transition between services, thus enabling older adults with dual diagnosis to receive the care that they required.

Most local dual diagnosis strategies have focused on adults of working age. This paper concentrates on a local strategy aimed at improving services for older people with mental health and substance misuse problems.

Adults with autism spectrum disorder (ASD) present with a range of psychiatric disorders. However, making an accurate diagnosis is challenging. It is important to follow a robust and informed process in the assessment of psychopathology that is centred on the individual and their neurodevelopmental difficulties. The purpose of this paper is to provide clinicians with an evidence-based approach to the assessment process for adults with ASD presenting with a possible co-occurrent psychiatric disorder.

A review of the recent literature was undertaken focusing on key papers that describe the assessment of mental health problems in adults with ASD.

The presentation of psychiatric symptoms is influenced by the underlying developmental disorder and it is often quite different from the one of the general population. Thus, it is essential to undertake a comprehensive psychopathological assessment including a diagnostic assessment of ASD. There is a very small evidence base on the use of diagnostic tools in the assessment of adults with ASD.

This is a practice review paper applying recent evidence from the literature.

The diagnosis of autism in adults often involves the use of tools recommended by NICE guidance but which are validated in children. The purpose of the paper is to establish the strength of the association between the Autism Diagnostic Interview-Revised (ADI-R) scores and the final clinical outcome in an all intellectual quotients adult autism diagnostic service and to establish if this in any way relates with gender and intellectual ability.

The sample includes referrals to Leeds Autism Diagnostic Service in 2015 that received a clinical outcome. Sensitivity, specificity and positive and negative predictive values were calculated to evaluate ADI-R and final clinical outcomes. Logistic regression model was used to predict the effect of the scores in all the domains of ADI-R and the two-way interactions with gender and intellectual ability.

ADI-R has a high sensitivity and low specificity and is useful to rule out the presence of autism, but if used alone, it can over diagnose. Restricted stereotyped behaviours are the strongest predictor for autism and suggests that the threshold should be increased to enhance its specificity.

This is a single site study with small effect size, so results may not be replicable. It supports the combined use of ADI-R and Autism Diagnostic Observation Schedule and suggests increasing ADI-R cut-offs to increase the specificity.

The clinical team may consider piloting a modified ADI-R as suggested by the results.

To the authors’ knowledge this is the only study of ADI-R in an adult population of all intellectual abilities.

Fetal alcohol spectrum disorder (FASD) is a complex lifelong disorder impacting the brain and body. Individuals with FASD may require lifelong supports and are at a higher risk of experiencing adverse outcomes, including incarceration. Individuals with FASD face stigma related to FASD that impacts disclosure of the diagnosis and access to supports. The prevalence of FASD exceeds that of other developmental disabilities, yet it remains less visible and stigmatized.

Interviews conducted with health-care and justice professionals in a Canadian province explore their experiences attending to FASD and challenges of stigma.

While difficult to access, diagnosis provides a pathway to supports and is crucial in the criminal justice process. Visibility and invisibility in health and justice systems highlight the lack of understanding of FASD and surrounding stigma. When unaddressed, individuals with FASD face additional challenges stemming from a lack of information and strategies by professionals involved in their lives.

Stigma represents a significant and complex issue intertwined in understandings of FASD. This research explores this relationship and the mechanisms through which FASD stigma has impacts in health-care and justice settings.

The purpose of this paper is to feedback the results of a survey of paediatric occupational therapists completed by the Paediatric Advisory Group (PAG) regarding perceptions and practices of the assessment of need (AON) process. This survey was completed to gather feedback from occupational therapists about the impact of the AON process on paediatric occupational therapy practice in Ireland.

A questionnaire was developed by the authors, who were on the PAG committee, to specifically gather quantitative and qualitative information about the AON. A snowball sampling method was utilised. The results were grouped into themes related to the practices and recommendations from occupational therapists nationally.

Surveys were returned from 98 paediatric occupational therapists with a wide national geographical spread with the majority working in the HSE. The amount of time spent on AON assessments, as well as the length of reports, varied nationally. The process of how assessments were completed (unidisciplinary or multidisciplinary) and whether a diagnosis was provided was inconsistent. Concerns were raised about the negative ethical impact of the AON on service provision and intervention and the need for further training of staff along with more frequent assessment reviews. The respondents also highlighted concerns about the increasing age of the AON criteria, with no increase in resources, and they provided suggestions for improvements for the future.

The survey was sent to all AOTI and PAG members via gatekeepers and then forwarded to others, resulting in a snowball sampling technique; however, this does not represent all paediatric occupational therapists nationally as membership in these groups is voluntary.

The concerns and inequities raised in the survey regarding occupational therapy practices of completing the AON process need to be shared with relevant stakeholders both at the occupational therapy management level and in the HSE and Department of Health/Disability. The PAG will continue to highlight these concerns from their members to relevant parties and by disseminating findings in articles such as this.

Ethical concerns were raised by some members about the equity of access to interventions as a result of the AON process. The social implication of this for families and children is pertinent, particularly in the context of the increased age in the AON criteria without any increase in resources.

The PAG aims to support paediatric occupational therapists nationally and the committee often gathers feedback from members regarding concerns which affect day-to-day practice in paediatric OT. Sharing of this information with IJOT readers helps to highlight the challenges faced by paediatric occupational therapists nationally.

The paper reports on a review of assessment scales commonly used for assessment of psychiatric illnesses or behaviour problems in adults with learning disabilities. Initially, a literature search was conducted to identify relevant peer‐reviewed journal publications pertaining to relevant scales. Those scales with more publications were reviewed with reference to the scale composition and psychometric properties. In total, eight behaviour scales, one psychiatric illness scale and three combined behaviour and psychiatric illness scales are reviewed.