Care and management of adults with autism spectrum disorder in family practice: difficulties experienced by general practitioners.

BACKGROUND AND OBJECTIVES: Few studies exist regarding the management and support of adults with autism spectrum disorder (ASD) in family practice. Most of them concern the management of children. As a primary care professional however, the general practitioner (GP) has a role to play at every step of the autistic adult's care pathway. With this study, we sought to identify GPs' experienced difficulties in caring for and managing their adult patients with ASD. METHODS: We conducted a qualitative study of 11 French GPs caring for adults with ASD via semistructured interviews and a thematic content analysis. GPs were recruited from 5 counties of the Grand Est Region (Marne, Haute-Marne, Meurthe-et-Moselle, Meuse and Vosges). RESULTS: All of the GPs described difficulties with the diagnostic process and the lack of initial training. Most of the respondents expressed difficulties with medical consultations of patients presenting an intellectual disability (ID) and with the lack of communication between GPs and mental health specialists during the patient care process. More than half of the GPs described difficulties with referral pathways for diagnosis due to lengthy delays and patient reluctance to seek psychiatric care. More than half of the respondents also experienced difficulties with providing proper social care, and with responding to patient distress due to their healthcare experiences. CONCLUSION: Improving awareness and training about ASD in adults, as well as harmonizing the diagnostic process and referral pathways, might reduce GPs' experienced difficulties in caring for this population.

Autism spectrum disorder (ASD) is a heterogeneous and lifelong disorder, which impacts the communication and social abilities of the person, including sometimes behavioral challenges. Adults with ASD are consequently exposed to psychiatric complications such as anxiety, depression, and suicide. The general practitioners (GPs) are on the frontline providing care for these patients. However, several studies show that GPs lack confidence in their ability to provide the best care for adults with ASD. We interviewed 11 French GPs from five counties in order to identify their difficulties managing adult patients with ASD. We found that they were challenged mostly by diagnostic and referral processes, by their lack of training, and by the insufficiency of communication with mental health specialists. These results highlight the need to organize and coordinate effective training in ASD and to facilitate the care process. This work also underscores the need for more collaboration and coordination between general practice and psychiatry in regard to a disorder for which both medical fields are needed. Addressing these issues is an opportunity to improve health care experiences for both patients and GPs.

Self-concept Clarity and Autobiographical Memory Functions in Adults with Autism Spectrum Disorder Without Intellectual Deficiency.

The structural characteristics of self-concept refer to the way in which the elements of self-knowledge are organized and can be experienced by individuals in the form of self-concept clarity. It is intimately linked to autobiographical memory. Therefore, we sought to compare self-concept clarity and autobiographical memory between adults with ASD without Intellectual Deficiency and controls. We also explored the association between self-concept clarity and autistic traits, autobiographical memory functions and executive functions. Statistical analyses were performed using Bayesian methods. Our results showed both a lower clarity of self-concept and a lower social function of autobiographical memory in the ASDwID than in the control group. We also presented a link between clarity of self-concept and the self-function of autobiographical memory.

Episodic Autobiographical Memory in Adults With Autism Spectrum Disorder: An Exploration With the Autobiographical Interview.

Introduction: The literature has provided contradictory results regarding the status of episodic memory in autism spectrum disorder (ASD). This might be explained by methodological differences across studies. In the present one, the well-recommended Autobiographical Interview was used in which important aspects of episodic memory were assessed, namely, the number and richness of phenomenological memory details, before and after a retrieval support. Method: Twenty-five well-documented adults with ASD without Intellectual Disability (nine women) and 25 control participants were included and asked to recall six specific autobiographical events. The number and richness of details were assessed globally and for five categories of details (perceptual/sensory, temporal, contextual, emotional, and cognitive), firstly before and then after a specific cueing phase consisting in a series of specific questions to elicit more precise memory details. Results: Cumulatively, from the spontaneous recall to the cueing phase, the number of internal details was lower in ASD individuals compared to controls, but this difference was relevant only after the specific cueing procedure and observed only for contextual details. In contrast, no relevant group difference was observed during spontaneous recall. The detail richness was not impaired in ASD throughout the Autobiographical Interview procedure. Conclusion: Our results speak against a clear impairment of episodicity of autobiographical memory in ASD individuals. They thus challenge previous ones showing both a reduced specificity and episodicity of autobiographical memory in this population and call for further studies to get a better understanding on the status of episodic autobiographical memory in ASD.

The Impact of Atypical Sensory Processing on Adaptive Functioning and Maladaptive Behaviors in Autism Spectrum Disorder During Childhood: Results From the ELENA Cohort.

Atypical sensory processing is common in autism spectrum disorders (ASD), but their role in adaptive difficulties and problem behaviors is poorly understood. Our aim was to determine the prevalence and type of atypical sensory processing in children with ASD and investigate its impact on their adaptive functioning and maladaptive behaviors. We studied a subsample of 197 children rigorously diagnosed with ASD from the ELENA cohort. Children were divided into atypical and typical sensory processing groups and several independent variables were compared, including adaptive functioning and maladaptive behaviors. Overall, 86.8% of the children had at least one atypical sensory pattern and all sensory modalities were disturbed. Atypical sensory processing explained a significant part of the variance of behavioral problems.