Recovery of adults with autism spectrum disorder during intensive inpatient treatment: a qualitative study.

Introduction: Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. Methods: This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Results: Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.

Self-reported Suicidality in Male and Female Adults with Autism Spectrum Disorders: Rumination and Self-esteem.

Rumination and low self-esteem are associated with suicidality, and with autism spectrum disorders (ASD). However, rumination and self-esteem in relation to suicidality in adults with ASD have not been examined. This cross-sectional study (n = 75; 46 males and 29 females) investigates the relation of rumination and self-esteem to the absence/presence of suicidal ideation (SUIC+/-), history of attempted suicide (HAS), and severity of suicidality. Multivariate analysis of variance showed that self-esteem was significantly associated with SUIC+/-, whereas rumination was significantly associated with HAS. Multiple regression analysis showed that rumination and self-esteem were independently associated with severity of suicidality, but these lose their significant contribution, when statistically controlling for depression. The prevalence of suicidal ideation was 66.6%; gender was not a significant factor.

Temperament and character as risk factor for suicide ideation and attempts in adults with autism spectrum disorders.

Persons with autism spectrum disorders (ASDs) are suggested to have an increased risk for suicide ideation and suicide attempts, but this topic is largely understudied. Research indicates that temperament and character traits are associated with suicidal behavior in persons without ASD, with higher scores for novelty seeking (NS), harm avoidance (HA), and self-transcedence (ST), and lower scores for self-directedness (SD) and cooperativeness (CO). Usually persons with ASD have temperament and character profiles with high HA, and low NS, reward dependence (RD), SD, and CO. The aim is to investigate whether there is a relationship between temperament and character traits and suicide ideation and attempts in adults with ASD. Seventy-four adults with ASD participated by completing self-report measures on suicide thoughts and behavior, depression, and temperament. Independent sample t-tests were conducted to compare scores between attempters versus nonattempters and between ideators versus nonideators. Regression analysis was performed to explore the predictive value of temperament and character. T-tests showed lower NS and SD, and higher HA for ideators versus nonideators, but not for attempters versus nonattempters. Regression models showed no significant relation between suicide ideation and NS, SD, HA after the latter were controlled for the significant influence of depression. Temperament and character can probably not be used for predicting suicide ideation and attempts, based on results from the current sample. Clinicians must take note of the high prevalence and risk of depression among persons with ASD, which may be under-reported. Autism Res 2020, 13: 104-111. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The aim of the current study was to uncover risk factors for suicide ideation and attempts in adults with autism, since this urgent topic is largely understudied. We initially investigated whether temperament and character could be risk factors, but found no association. However, we did find that depression might be a high predictor for suicide ideation, which could remain under-reported in adults with autism, due to impaired communication and problems with expressing emotions and thoughts.

Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders.

Anxiety and depression co-occur in 50-70% of adults with autism spectrum disorder (ASD) but treatment methods for these comorbid problems have not been systematically studied. Recently, two ASD-tailored protocols were published: mindfulness based stress reduction (MBSR) and cognitive behavioural therapy (CBT). We wanted to investigate if both methods are equally effective in reducing anxiety and depression symptoms among adults with ASD. 59 adults with ASD and anxiety or depression scores above 7 on the Hospital Anxiety and Depression Scale, gave informed consent to participate; 27 followed the CBT protocol, and 32 the MBSR treatment protocol. Anxiety and depression scores, autism symptoms, rumination, and global mood were registered at the start, at the end of the 13-week treatment period, and at 3-months follow-up. Irrational beliefs and mindful attention awareness were used as process measures during treatment and at follow-up. Results indicate that both MBSR and CBT are associated with a reduction in anxiety and depressive symptoms among adults with ASD, with a sustained effect at follow-up, but without a main effect for treatment group. A similar pattern was seen for the reduction of autistic symptoms, rumination and the improvement in global mood. There are some indications that MBSR may be preferred over CBT with respect to the treatment effect on anxiety when the scores on measures of irrational beliefs or positive global mood at baseline are high. Mindfulness and cognitive behavioral therapies are both promising treatment methods for reducing comorbid anxiety and depression in adults with ASD.

Predictive validity of self-report questionnaires in the assessment of autism spectrum disorders in adults.

While various screening instruments for autism spectrum disorders are widely used in diagnostic assessments, their psychometric properties have not been simultaneously evaluated in the outpatient setting where these instruments are used most. In this study, we tested the Ritvo Autism Asperger Diagnostic Scale-Revised and two short versions of the Autism-Spectrum Quotient, the AQ-28 and AQ-10, in 210 patients referred for autism spectrum disorder assessment and in 63 controls. Of the 210 patients, 139 received an autism spectrum disorder diagnosis and 71 received another psychiatric diagnosis. The positive predictive values indicate that these tests correctly identified autism spectrum disorder patients in almost 80% of the referred cases. However, the negative predictive values suggest that only half of the referred patients without autism spectrum disorder were correctly identified. The sensitivity and specificity of each of these instruments were much lower than the values reported in the literature. In this study, the sensitivity of the Ritvo Autism Asperger Diagnostic Scale-Revised was the highest (73%), and the Autism-Spectrum Quotient short forms had the highest specificity (70% and 72%). Based on the similar area under the curve values, there is no clear preference for any of the three instruments. None of these instruments have sufficient validity to reliably predict a diagnosis of autism spectrum disorder in outpatient settings.

Temperament and character as endophenotype in adults with autism spectrum disorders or attention deficit/hyperactivity disorder.

Autism spectrum disorder and attention deficit/hyperactivity disorder overlap in several ways, raising questions about the nature of this comorbidity. Rommelse et al. published an innovative review of candidate endophenotypes for autism spectrum disorder and attention deficit/hyperactivity disorder in cognitive and brain domains. They found that all the endophenotypic impairments that were reviewed in attention deficit/hyperactivity disorder were also present in autism spectrum disorder, suggesting a continuity model with attention deficit/hyperactivity disorder as "a light form of autism spectrum disorder." Using existing data, 75 adults with autism spectrum disorder and 53 with attention deficit/hyperactivity disorder were directly compared on autistic symptoms with the autism spectrum quotient, and on the endophenotypic measure of temperament and character, using the Abbreviated (Dutch: Verkorte) Temperament and Character Inventory. Based on the hypothesis that attention deficit/hyperactivity disorder and autism spectrum disorder are disorders on a continuous spectrum, autism spectrum quotient scores and abbreviated Temperament and Character Inventory scores were expected to be different from normal controls in both disorders in a similar direction. In addition, the autism spectrum quotient and abbreviated Temperament and Character Inventory scores were expected to be closely correlated. These conditions applied to only two of the seven Abbreviated Temperament and Character Inventory scales (harm avoidance and self-directedness), suggesting that temperament and character as an endophenotype of autism spectrum disorder and attention deficit/hyperactivity disorder provides only partial support for the continuity hypothesis of autism spectrum disorder and attention deficit/hyperactivity disorder.

Using the Autism-spectrum quotient to discriminate Autism Spectrum Disorder from ADHD in adult patients with and without comorbid Substance Use Disorder.

It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA's were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating characteristic (ROC) computations to assess discriminant power. All but one of the mean AQ (sub)scores were significantly higher for adults with ASD compared to those with ADHD. The SUD status in general was not significantly associated with AQ (sub)scores. On the Social Skills subscale patients with ASD and comorbid SUD showed less impairment than those without SUD. The cut-off score 26 yielded 73% correct classifications. The clinical use of the AQ in differentiating between ASD and ADHD is limited.