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Article
Publication date: 5 July 2021

Michelle Heyman, Megan Ledoux Galligan, Giselle Berenice Salinas, Elizabeth Baker, Jan Blacher and Katherine Stavropoulos

Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are…

Abstract

Purpose

Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are appropriate. Differentiating among neurodevelopmental disorders such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder and intellectual disability can be a complex process, especially, as these disorders have some overlapping symptoms and often co-occur in young children. This series of case studies aims to present commonly overlapping symptoms in children who present to clinics with developmental concerns.

Design/methodology/approach

This paper presents three case studies that were completed at a free community ASD screening clinic in Southern California.

Findings

The case studies have common presenting behaviors and symptoms (e.g. social communication difficulties) that often co-occur across diagnoses; explanations for the final diagnoses are given in each case.

Research limitations/implications

Conclusions from these three cases cannot generalize to all children being seen in clinics for neurodevelopmental concerns.

Practical implications

This series of case studies highlights commonly overlapping symptoms in children who present for differential diagnosis with social and/or behavioral concerns. Implications for educational placement and intervention are discussed.

Social implications

These cases highlight the challenges involved in the differential and dual diagnostic process for young children with developmental concerns. Diagnostic considerations can affect later educational placement and opportunities for socialization.

Originality/value

This series of case studies provide practical information for clinicians about how to effectively differentiate between commonly occurring neurodevelopmental disorders, particularly given recent changes to the Diagnostic and Statistical Manual, 5th edition (DSM-5).

Details

Advances in Autism, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-3868

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Article
Publication date: 2 April 2010

Sara Evans‐Lacko and Graham Thornicroft

Although we know that stigma is associated with having either a diagnosis of mental illness or a substance abuse disorder, evidence about whether stigma and discrimination…

Abstract

Although we know that stigma is associated with having either a diagnosis of mental illness or a substance abuse disorder, evidence about whether stigma and discrimination are experienced differently, or at higher levels, for people with co‐occurring mental illness and substance abuse is unclear. Given the high prevalence of co‐occurring disorders and the high levels of need among people with co‐occurring disorders, understanding the varying levels of stigma and barriers to care encountered by this group is important for healthcare practitioners.

Details

Advances in Dual Diagnosis, vol. 3 no. 1
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 10 July 2017

Penelope Jane Standen, Adam Clifford and Kiran Jeenkeri

The purpose of this paper is to provide information for non-specialists on identifying the characteristics, assessment and support needs of people with intellectual…

Abstract

Purpose

The purpose of this paper is to provide information for non-specialists on identifying the characteristics, assessment and support needs of people with intellectual disabilities (ID) accessing mainstream services.

Design/methodology/approach

A review of relevant policy and research literature is supplemented with observations from the authors’ own experience of working in mental health services for people with ID.

Findings

With change in provision of services the likelihood of mainstream staff encountering someone with ID will increase. However, information on whether a person has ID or their level of ID is not always available to professionals in acute mental health services meeting an individual for the first time. Reliance on observational and interview-based assessments can leave people with ID vulnerable to a range of over- and under-diagnosis issues. This is as a result of difficulties with communication and emotional introspection, psychosocial masking, suggestibility, confabulation and acquiescence. For people with poor communication, carers will be the primary source of information and their contribution has to be taken into account.

Practical implications

Knowing or suspecting an individual has ID allows staff to take into account the various assessment, diagnosis and formulation issues that complicate a valid and reliable understanding of their mental health needs. Awareness about an individual’s ID also allows professionals to be vigilant to their own biases, where issues of diagnostic overshadowing or cognitive disintegration may be important considerations. However, understanding some of the practical and conceptual issues should ensure a cautious and critical approach to diagnosing, formulating and addressing this population’s mental health needs.

Originality/value

This synthesis of a review of the literature and observations from the authors’ experience of working in mental health services for people with ID provides an informed and practical briefing for those encountering people with ID accessing mainstream services.

Details

The Journal of Mental Health Training, Education and Practice, vol. 12 no. 4
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 11 March 2021

Bethany Driver and Verity Chester

Autistic women and girls have received comparatively less attention within clinical practice and research. Research suggests women tend to be diagnosed later than men, and…

Abstract

Purpose

Autistic women and girls have received comparatively less attention within clinical practice and research. Research suggests women tend to be diagnosed later than men, and are more likely to experience misdiagnosis.

Design/methodology/approach

This paper aims to report a narrative literature review that examines research on the presentation, recognition, and diagnosis of autistic women and girls.

Findings

Findings suggest that autistic females present differently to males and highlight low recognition of the female presentation of autism among the general public, in social spheres, educational, clinical and forensic settings. This lack of recognition appears to affect the likelihood of females being referred for diagnosis, the reliability of diagnostic assessments and subsequent access to support.

Originality/value

Recommendations for clinical practice focus on initiatives to increase awareness of the female presentation of autism, improving the diagnostic process for females, increasing female representation within autism training and for future research to support these goals.

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Article
Publication date: 21 February 2020

Ann Marie Martin, Katherine Stavropoulos and Jan Blacher

Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process…

Abstract

Purpose

Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.

Design/methodology/approach

Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.

Findings

The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.

Originality/value

More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.

Details

Advances in Autism, vol. 6 no. 2
Type: Research Article
ISSN: 2056-3868

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Article
Publication date: 3 March 2014

Trine Lise Bakken, Arvid Nikolai Kildahl, Vibeke Gjersøe, Espen Matre, Tone Kristiansen, Arvid Ro, Anne Louise Tveter and Siv Helene Høidal

The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in…

Abstract

Purpose

The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities.

Design/methodology/approach

The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five patients all met criteria for PTSD according to the Diagnostic Manual – Intellectual Disability.

Findings

Previously, it was not suspected that the five patients suffered from PTSD, although they had experienced terrifying incidents. All patients displayed severe changes in behaviour, which may have overshadowed symptoms of PTSD. PTSD in persons with more severe intellectual disabilities may be interpreted as challenging behaviour, or other psychiatric disorders such as psychosis.

Research limitations/implications

The limitation of the study is the small number of participants.

Practical implications

Practical implication is linked to clinical practice related to identification of PTSD in persons with intellectual disabilities.

Originality/value

The paper may encourage more research into how PTSD can be identified in persons with moderate and severe intellectual disabilities. The case reports may help clinicians to look for traumatic experiences in persons with intellectual disabilities who have experienced terrifying incidents.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 8 no. 2
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 1 April 1999

Steve Moss

This paper examines the process of assessing mental health needs for people with learning disabilities, considering questions of targeting, mental illness and challenging…

Abstract

This paper examines the process of assessing mental health needs for people with learning disabilities, considering questions of targeting, mental illness and challenging behaviour, diagnostic assessment and quality of life. It recommends comprehensive assessment within an integrated care approach.

Details

Tizard Learning Disability Review, vol. 4 no. 2
Type: Research Article
ISSN: 1359-5474

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Article
Publication date: 9 July 2021

Solomon Shatananda, Abimbola Oyedokun, Mahesh Odiyoor, Sujeet Jaydeokar and Saman Shahzad

The purpose of the study is to identify and ascertain if there were any validated tools for diagnosing or screening autism spectrum disorder in adults with ID. The…

Abstract

Purpose

The purpose of the study is to identify and ascertain if there were any validated tools for diagnosing or screening autism spectrum disorder in adults with ID. The estimated prevalence of intellectual disability (ID) in the general population is about 10.37/1,000 population (Maulik et al., 2011). In total, 1 out of 4 individuals with ID suffers from an autism spectrum disorder (ASD) (Sappok et al., 2010). Early diagnosis and support for ASD is key to having a good quality of life. The diagnosis of ASD in people with an ID presents its own challenges and it is likely under-identification of ASD amongst adults with ID by about 20% to 30% (Emerson and Baines, 2010).

Design/methodology/approach

Studies were selected based on the following criteria: studies that reported either screening or diagnostic tools for ASD, participants had an ID i.e. a mean IQ of <70, adults i.e. participants were >18 years of age at the time of entry to the study and articles reported either sensitivity, specificity or area under the curve. Relevant studies that were published up to January 2020 were identified from EMBASE, PsychINFO, CINAHL and PubMed. In total, 75 papers were identified of which 15 papers met the criteria.

Findings

The screening or diagnostic tools currently in use is dependant on the degree of ID. A number of the tools had good psychometric properties and utility when used in people with specific degrees of ID or when used in combination with another screening or diagnostic tool. The authors could not identify a diagnostic tool that could be used across all levels of severity of ID unless used in combination. Hence, concluded that there is a need for a diagnostic tool with good psychometric properties for the assessment of ASD in adults with all degree of ID within a reasonable time period without the need for an additional tool to be used in conjunction.

Originality/value

Currently, the “gold standard” for diagnosing ASD is a lengthy and time-consuming process carried out by trained multi-disciplinary team members who assess historical, behavioural and parent/carer report to arrive at a diagnosis. There are a number of tools that have been developed to aid diagnosis. However, it is important to identify the tools that can optimise the procedures and are also time-efficient.

Details

Advances in Autism, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-3868

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Article
Publication date: 7 September 2015

Marco O. Bertelli, Michele Rossi, Daniela Scuticchio and Annamaria Bianco

Diagnosing psychiatric disorders (PD) in adults with Intellectual Disability (ID) presents several issues and need specific skills and tools. The purpose of this paper is…

Abstract

Purpose

Diagnosing psychiatric disorders (PD) in adults with Intellectual Disability (ID) presents several issues and need specific skills and tools. The purpose of this paper is to provide a detailed description of the current status of art through a systematic mapping of the literature.

Design/methodology/approach

The authors reviewed the international literature on the basis of the following questions: what are the issues in the psychiatric diagnostic process for adults with ID? What methods and procedures have been used for psychiatric assessment in ID? To date, is it possible to identify some most effective procedures?

Findings

The analysis of the literature indicates that main issues of the psychiatric diagnostic process in adults with ID are the following: identification of psychiatric symptoms, behavioural equivalents, diagnostic criteria, setting, source of information, screening, and diagnostic tools. The evidence base is only emerging and although many relevant achievements have been reached in the last two decades, no definitive guideline has been produced. Most recent acquisition also allowed to identify some assessment procedures that are currently considered the most effective. Individualised assessment remains the best way to meet the needs of this heterogeneous and variable patient group.

Originality/value

This paper offers a comprehensive and updated description of current achievements and issues towards the assessment of PD in people with ID.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 7 March 2016

Ross Spackman, Adnan Qureshi and Dheeraj Rai

The purpose of this paper is to amalgamate recommendations from contemporary national reports on healthcare provision and needs of people with intellectual disabilities…

Abstract

Purpose

The purpose of this paper is to amalgamate recommendations from contemporary national reports on healthcare provision and needs of people with intellectual disabilities. The paper combines these with recommendations for undergraduate curricula of medical students from the GMC and Royal College of Psychiatrists (RCPsych).

Design/methodology/approach

National reports from Mencap, Department of Health, Disability rights commission, NHS Executive, the GMC and RCPsych were searched for relevant recommendations to undergraduate medical education in ID psychiatry. Recommendations were collated and grouped to form a single list for use when planning future curricula or auditing existing teaching.

Findings

In total, 13 relevant recommendations were identified in nine groups. These included that people with intellectual disabilities and their carers should be involved in the teaching. That teaching should include the ethical, moral and legal obligations and should include the mental capacity act and equality act. Institutional and individual discrimination should be highlighted as a problem and diagnostic overshadowing should be covered.

Originality/value

This paper has collated in a single document the combined recommendations of multiple reports. These are relevant to medical undergraduate teaching and may also be of use to other undergraduate healthcare courses. They are a useful template for others wishing to examine or benchmark the content of their medical undergraduate ID psychiatry teaching against an amalgamated list.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 2
Type: Research Article
ISSN: 2044-1282

Keywords

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