Autism Diagnosis in the United Kingdom: Perspectives of Autistic Adults, Parents and Professionals.

Accessing an autism diagnosis is a key milestone, both for an individual and their family. Using a qualitative methodology, the current study examined the views and experiences of ten autistic adults, ten parents of children on the autism spectrum, and ten professionals involved in autism diagnosis, all based in the United Kingdom (UK). Interviewing these 30 respondents about the diagnostic process and subsequent support options, the goal was to identify aspects of the diagnostic process that are working well, and areas in which improvements are needed. Using thematic analysis, three key themes were identified: the process of understanding and accepting autism; multiple barriers to satisfaction with the diagnostic process; and inadequate post-diagnostic support provision.

Experiences of diagnosing autism spectrum disorder: A survey of professionals in the United Kingdom.

To date, research exploring experiences of diagnosing autism spectrum disorder has largely focused on parental perspectives. In order to obtain a more complete account of the autism spectrum disorder diagnostic process, it is essential that the views and experiences of professionals are heard. In this study, 116 multidisciplinary professionals involved in diagnosing autism spectrum disorder in the United Kingdom completed an online questionnaire exploring their experiences and opinions of three key areas of service: accessibility, the diagnostic process and post-diagnostic support. Although professionals were largely satisfied with service accessibility, around 40% of services were failing to provide timely assessments. Standardised diagnostic tools were perceived as helpful and were used consistently, but concerns were raised about their validity in detecting atypical autism spectrum disorder presentations (e.g. females). Several challenges regarding giving autism spectrum disorder diagnoses were reported; these included making sure caregivers understood the diagnosis, pitching information at the correct level and managing distress. Furthermore, the practice of 'upgrading' to a diagnosis of autism spectrum disorder in uncertain or complex cases was reported by many, albeit infrequently, and reasons for this varied widely. Professionals expressed dissatisfaction with post-diagnostic provision, especially onward and long-term support options. They also felt that service improvements were required across populations and across the three key areas of service.

Experiences of autism diagnosis: A survey of over 1000 parents in the United Kingdom.

A sample of 1047 parents completed an online survey about their experiences and opinions regarding the process of attaining a diagnosis of autism spectrum disorder for their children. The results revealed that parents usually waited a year from when they first had concerns about their child's development before they sought professional help. On average, there was a delay of around 3.5 years from the point at which parents first approached a health professional with their concerns to the confirmation of an autism spectrum disorder diagnosis. Just over half of the parents surveyed were dissatisfied with the diagnostic process as a whole. Several factors predicted parents' overall levels of satisfaction with the diagnostic process, including the time taken to receive a diagnosis, satisfaction with the information provided at diagnosis, the manner of the diagnosing professional, the stress associated with the diagnostic process and satisfaction with post-diagnostic support. Post-diagnosis, the support (if any) that was provided to parents was deemed unsatisfactory, and this was highlighted as an area of particular concern among parents.

Experiences of receiving a diagnosis of autism spectrum disorder: a survey of adults in the United kingdom.

A total of 128 adults with high-functioning autism spectrum disorders were surveyed concerning the process they went through to obtain their diagnosis and the subsequent support they received. Results suggested that routes to diagnosis were quite heterogeneous and overall levels of satisfaction with the diagnostic process were mixed; 40 % of respondents were 'very/quite' dissatisfied, whilst 47 % were 'very/quite' satisfied. The extent of delays, number of professionals seen, quality of information given at diagnosis and levels of post-diagnostic support predicted overall satisfaction with the diagnostic process. Important areas and suggestions for improvement were noted for all stages of the diagnostic pathway. Respondents also displayed above average levels of depressed mood and anxiety, with greater support being requested in this area.

A preliminary study of gender differences in autobiographical memory in children with an autism spectrum disorder.

Autobiographical memory was assessed in 24 children (12 male, 12 female, aged between 8 and 16 years) with autism spectrum disorder (ASD) and a comparison group of 24 typically developing (TD) children matched for age, IQ, gender and receptive language. Results suggested that a deficit in specific memory retrieval in the ASD group was more characteristic of male participants. Females in both the TD and ASD groups generated more detailed and emotional memories than males. They also demonstrated superior verbal fluency scores; verbal fluency and autobiographical memory cueing task performance were significantly positively correlated in females. Results are discussed in light of recent research suggesting gender differences in the phenotype of ASD.

Development of autobiographical memory in children with autism spectrum disorders: deficits, gains, and predictors of performance.

Autobiographical memory (AM) was assessed in 63 children (aged 8-17 years) with an autism spectrum disorder (ASD) and compared with 63 typically developing children matched for age, gender, IQ, and verbal ability. A range of methodologies was employed for eliciting past experience with particular focus on the ability to recall (a) specific events, (b) the recent and remote past, and (c) semantic versus episodic memories across different lifetime periods. Results indicated that the ASD group manifested difficulties in retrieving specific memories to word cues and had poorer access to the remote past. Deficits were found in the context of intact recent memory and preserved general memory abilities, with some impairment of visual memory. Problems in retrieving episodic and semantic AMs across the life span were also evident. Qualitative analysis of memory reports suggested that the ASD group was less likely to refer to emotion in their remote memories but more likely to describe emotions in their recent memories. Important predictors of AM performance in the ASD group were central executive abilities, in particular cognitive flexibility and verbal fluency.

Autobiographical memory in adults with autism spectrum disorder: the role of depressed mood, rumination, working memory and theory of mind.

Autobiographical memory difficulties have been widely reported in adults with autism spectrum disorder (ASD). The aim of the current study was to explore the potential correlates of autobiographical memory performance (including depressed mood, rumination, working memory and theory of mind) in adults with ASD, relative to a group of typical adults matched for age, gender and IQ. Results demonstrated that the adults with ASD reported higher levels of depressed mood and rumination than the typical adults, and also received lower scores on measures of theory of mind and working memory. Correlational analysis suggested that theory of mind and working memory were associated with autobiographical memory performance in the adults with ASD, but no significant relationships were observed between autobiographical memory, depressed mood and rumination in this group. To explore these patterns further, two cases of adults with a dual diagnosis of ASD and depression are discussed. These participants present a profile in line with the idea that depressed mood and rumination do not have the same influence on autobiographical memory in adults with ASD as they do in typical adults.

Patterns of autobiographical memory in adults with autism spectrum disorder.

Two studies are presented that explored the effects of experimental manipulations on the quality and accessibility of autobiographical memories in adults with autism spectrum disorder (ASD), relative to a typical comparison group matched for age, gender and IQ. Both studies found that the adults with ASD generated fewer specific memories than the comparison group, and took significantly longer to do so. Despite this, experimental manipulations affected two indices of autobiographical memory (specificity and retrieval latency) similarly in both groups. These results suggest that adults with ASD experience a quantitative reduction in the speed and specificity of autobiographical memory retrieval, but that when they do retrieve these memories, they do so in a way that is qualitatively similar to that of typical adults.

A randomised controlled single-blind trial of the efficacy of reiki at benefitting mood and well-being.

This is a constructive replication of a previous trial conducted by Bowden et al. (2010), where students who had received Reiki demonstrated greater health and mood benefits than those who received no Reiki. The current study examined impact on anxiety/depression. 40 university students-half with high depression and/or anxiety and half with low depression and/or anxiety-were randomly assigned to receive Reiki or to a non-Reiki control group. Participants experienced six 30-minute sessions over a period of two to eight weeks, where they were blind to whether noncontact Reiki was administered as their attention was absorbed in a guided relaxation. The efficacy of the intervention was assessed pre-post intervention and at five-week follow-up by self-report measures of mood, illness symptoms, and sleep. The participants with high anxiety and/or depression who received Reiki showed a progressive improvement in overall mood, which was significantly better at five-week follow-up, while no change was seen in the controls. While the Reiki group did not demonstrate the comparatively greater reduction in symptoms of illness seen in our earlier study, the findings of both studies suggest that Reiki may benefit mood.

Judgements of self-understanding in adolescents with Asperger syndrome.

Previous research has demonstrated that adults with high functioning autism (HFA)/Asperger syndrome (AS) judge others as having as much knowledge about their inner mental states as they do. The current study examined whether this pattern also applies to adolescents with HFA/AS because typically developing adolescents, in contrast to younger children, regard themselves as experts on their own inner states. Twenty-two adolescents with HFA/AS and 22 controls judged how much they versus a comparison person knew about 6 aspects of their inner states. In contrast to typically developing adolescents, those with HFA/AS judged the comparison person as having more knowledge about themselves than they did. This study suggests that adolescents with HFA/AS have more pronounced difficulties with this aspect of self-knowledge than do adults with this condition. The implications of this deficit for social functioning are discussed.

Brief Report: Self-defining and everyday autobiographical memories in adults with autism spectrum disorders.

Autobiographical memory impairments in autism spectrum disorders (ASD) have been attributed to a failure in using the self as an effective memory organisational system. To explore this hypothesis, we compared self-defining and everyday memories in adults with and without ASD. Results demonstrated that both groups were able to distinguish between self-defining and everyday memories, although the ASD group generated fewer specific memories overall. Despite qualitative similarities between the narratives of the two groups, the adults with ASD extracted less meaning from their narratives. Difficulties in eliciting meaning from memories suggests a failure in using past experiences to update the self. We therefore propose that the self-memory relationship might be static, rather than dynamic, in ASD.

A randomised controlled single-blind trial of the effects of Reiki and positive imagery on well-being and salivary cortisol.

The study investigated whether participants who received Reiki would show greater health and well-being benefits than a group who received no Reiki. A method of blinding participants to Reiki was also tested, where non-contact Reiki or No-Reiki with random assignment was given to 35 healthy psychology undergraduates whose attention was absorbed in one of three tasks involving self-hypnosis/relaxation. Participants experienced ten 20-min intervention sessions over a period of two and a half to 12 weeks. Reiki was directed by the experimenter who sat behind the participants as they were absorbed in the tasks. Self-report measures of illness symptoms, mood and sleep were assessed pre-post-intervention as was salivary cortisol. While the Reiki group had a tendency towards a reduction in illness symptoms, a substantive increase was seen in the No-Reiki. The Reiki group also had a near-significant comparative reduction in stress, although they also had significantly higher baseline illness symptoms and stress scores. The Reiki blinding was successful - the groups did not differ statistically in their beliefs regarding group membership. The results are suggestive that the Reiki buffered the substantive decline in health in the course of the academic year seen in the No-Reiki group.

Executive functions in children with autism spectrum disorders.

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N=54, all IQ > or = 70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.

Specific and general autobiographical knowledge in adults with autism spectrum disorders: the role of personal goals.

Autobiographical knowledge is stored hierarchically, at both specific and general levels of representation. It has also been proposed that the self is the structure around which autobiographical memories are organised. The current series of studies assessed whether the autobiographical memory difficulties observed in adults with autism spectrum disorders (ASD) could be due to problems in using the self as an effective memory cue. A series of cueing paradigms were used to assess the accessibility of both specific and general autobiographical knowledge relating to (i) currently pursued goals (either high or low in self-concordance) and (ii) goals that participants were not currently pursuing. Results demonstrated that while event-specific knowledge was impaired in the ASD group, general event knowledge appeared relatively intact. Moreover, while both event-specific and general event knowledge were organised around goals of the self in control participants, a corresponding relationship was only observed for general event knowledge in the ASD group.

Sensory processing in adults with autism spectrum disorders.

Unusual sensory processing has been widely reported in autism spectrum disorders (ASDs); however, the majority of research in this area has focused on children. The present study assessed sensory processing in adults with ASD using the Adult/Adolescent Sensory Profile (AASP), a 60-item self-report questionnaire assessing levels of sensory processing in everyday life. Results demonstrated that sensory abnormalities were prevalent in ASD, with 94.4 percent of the ASD sample reporting extreme levels of sensory processing on at least one sensory quadrant of the AASP. Furthermore, analysis of the patterns of sensory processing impairments revealed striking within-group variability in the ASD group, suggesting that individuals with ASD could experience very different, yet similarly severe, sensory processing abnormalities. These results suggest that unusual sensory processing in ASD extends across the lifespan and have implications regarding both the treatment and the diagnosis of ASD in adulthood.

Episodic and semantic autobiographical memory in adults with autism spectrum disorders.

Episodic and semantic autobiographical memories were examined in a group of adults with autism spectrum disorders (ASD) and a control group matched for age, gender and IQ. Results demonstrated a personal episodic memory deficit in the ASD group in the absence of a personal semantic memory deficit, suggesting a deficit dissociation between these two components of memory in ASD. Further analysis of memories across different lifetime periods revealed the adolescent and early adult lifetime periods to facilitate memory recall in the control group, but not in the ASD group. These findings suggest a distinctive pattern of remembering in ASD.

Autobiographical memory and social problem-solving in Asperger syndrome.

Difficulties in social interaction are a central feature of Asperger syndrome. Effective social interaction involves the ability to solve interpersonal problems as and when they occur. Here we examined social problem-solving in a group of adults with Asperger syndrome and control group matched for age, gender and IQ. We also assessed autobiographical memory, on a cueing task and during social problem-solving, and examined the relationship between access to specific past experiences and social problem-solving ability. Results demonstrated a social problem-solving impairment in the Asperger group. Their solutions were less detailed, less effective and less extended in time. Autobiographical memory performance was also impaired with significantly longer latencies to retrieve specific memories and fewer specific memories retrieved in comparison to controls.

The effects of cue modality on the quality of personal memories retrieved.

We investigated the effect of cue modality on the specificity, speed, vividness, and age of autobiographical memory retrieval. Cues were presented as either an odour, a visual image, or a word label. Odour-cued memories were older, more likely to be categoric, and were slower to be retrieved. Few gender differences were found although females reported more vivid memories than males. We suggest that cue modality directly affects retrieval processes; odour cues are more likely to initiate a perceptual search strategy, in contrast to memories cued by visual images and words, which are usually conceptually/verbally mediated.