The purpose of the paper is to review autism identification across different ethnic groups. Diagnosis of autism may be missed or delayed in certain ethnic groups, leading to such groups being underserved relative to their needs. This can result in members of such groups being effectively denied essential avenues of support that can substantially improve the quality of life of autistic persons as well as those whom care for them.
Tromans, S., Chester, V., Gemegah, E., Roberts, K., Morgan, Z., Yao, Q.L., & Brugha, T.Read research
The purpose of this paper is to provide a commentary on “being diagnosed with autism in adulthood: a personal case study”.
Many individuals are not diagnosed with autism until their adult life, and as a result, miss the benefits of timely introduction of sources of support, such as during their schooling. Receiving an autism diagnosis can come as a relief and promote self-understanding, but availability of high-quality post-diagnostic support services and accommodating employers are both highly important.
Tromans, S. & Chester, VRead research
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.
This paper aims to report a narrative literature review that examines research on the presentation, recognition, and diagnosis of autistic women and girls.
Driver, B. & Chester, V.Read research
Attention-deficit hyperactivity disorder (ADHD) is common among people with intellectual disability. Diagnosing ADHD in this clinically and cognitively complex and diverse group is difficult, given the overlapping psychiatric and behavioural presentations. Underdiagnoses and misdiagnoses leading to
irrational polypharmacy and worse health and social outcomes are common. Diagnostic interviews exist, but are cumbersome and not in regular clinical use.
We aimed to develop a screening tool to help identify people with intellectual disability and ADHD.
Sawhney, I., Perera, B., Bassett, P., Zia, A., Alexander, R. T., & Shankar, R.Read research
Working with Autistic People in the Criminal Justice and Forensic Mental Health Systems: A Handbook for Practitioners is the first book to focus specifically on best practice for working with autistic people in criminal justice and forensic mental health settings. Integrating current theory, research, and clinical practice, this book provides a practical guide for multidisciplinary practitioners working with autistic people who have offended, at all stages in their pathway, regardless of the nature of offending.
The book draws together contributions from leading scholarly and clinical experts in the field of autism and forensic issues as well as the views of autistic people under the care of forensic services. Each chapter focuses on understanding the impact of autism throughout the criminal justice and forensic mental health system pathways, including how these systems are experienced by autistic people and their families and carers. Case studies and practical approaches are provided to demonstrate the application of best practice to working with autistic people in secure settings.
Chester, V., Driver, B., & Alexander, R.T.Read research
Diagnosing personality disorders (PDs) in persons with intellectual disability (PwID) or those with both intellectual disability and autism spectrum disorder (PwID-ASD) can be challenging since it requires subjective information about thoughts and emotions and adequate communication skills. This is compounded by a lack of clarity relating to core concepts of personality disorder in this population as well as a blurring of boundaries between personality, autism, psychiatric illness and problem behaviours. The longstanding and integral maladaptive patterns of cognition, emotion and behaviour impact significantly on psychosocial functioning and incur high societal costs. As important moderators of mental state and physical disorders, PDs impact significantly on general wellbeing and the ability of individuals to thrive in the community. Overall, there is a paucity of good quality studies about PDs in PwID, and hence, treatment strategies are largely extrapolated from empirical evidence in the general population. This chapter summarises the diagnosis, assessment, epidemiology, aetiology, treatments and treatment outcomes within the context of the current evidence base.
Cooray, S.E., Alexander, R., Purandare, K., Chester, V., Tyrer, P.Read research
The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions – New South Wales in Australia; Norway; England and Wales – to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.
Cooray, S.E., Alexander, R., Purandare, K., Chester, V., Tyrer, P.Read research
Trauma-focused guided self-help (TF-GSH) is an important alternative to psychological therapy delivered by a therapist. This meta-analysis evaluates the efficacy of TF-GSH in reducing posttraumatic stress disorder (PTSD) symptoms and comorbid depressive and anxiety symptoms. A total of 17 trials were included that compared a TF-GSH intervention (N = 610) to various control comparators (N = 570). Control conditions included treatment as usual (k = 2), waiting list (k = 11), phone monitoring (k = 1), nontrauma writing (k = 1), general support (k = 1), and supportive counseling (k = 1). A moderate- to large-sized effect favouring TF-GSH was observed for PTSD (k = 17, g = −0.81, 95% confidence interval [CI]: −1.24, −0.39) and a moderate-sized effect was observed for depressive (k = 13, g = −0.73, 95% CI: −1.16, −0.31) and anxiety (k = 11, g = −0.72, 95% CI: −1.18, −0.27) symptoms, with considerable heterogeneity. Moderator analyses were all not statistically significant. Results indicate that TF-GSH is a promising treatment for PTSD and comorbid depressive and anxiety symptoms. We discuss the nature, extent, and quality of the literature to provide a point of departure for future research. TF-GSH (and unguided self-help) may not be appropriate for certain individuals at certain times. Exploring a broad range of treatment delivery modalities will move the field closer towards a model of evidence-based care in which the likely appropriate dose and type of intervention can be matched to individuals based on presenting problems and other variables.
Siddaway, A.P., Meiser-Stedman, R., Chester, V., Finn, J., O Leary, C., Peck, D. & Loveridge, C.Read research
Jesu, A.J.M., Gangadharan, S.K., Bhaumik, S., & Alexander, R.T.Read research
Psychological stress has an established bi-directional relationship with obesity. Mindfulness techniques reduce stress and improve eating behaviours, but their long-term impact remains untested. CALMPOD (Compassionate Approach to Living Mindfully for Prevention of Disease) is a psychoeducational mindfulness-based course evidenced to improve eating patterns across a 6-month period, possibly by reducing stress. However, no long-term evaluation of impact exists.
This study retrospectively evaluates 2-year outcomes of CALMPOD on patient engagement, weight and metabolic markers.
Hanson, P., Lange, M., Oduro-Donkor, D., Shuttlewood, E., Weickert, M.O., Randeva, H.S., Menon, V., Alexander, R.T., Basset, P., Shankar, R., & Barber, T.M.Read research
An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists.
The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care.
Melvin, C. L., Barnoux, M., Alexander, R., Roy, A., Devapriam, J., Blair, R., Tromans, S., Shepstone, L., & Langdon, P. E.Read research
We examined whether a series of variables were related to the number of psychiatric inpatients using publicly available data about English psychiatric bed utilisation and NHS workforce.
Langdon, P. E., Thompson, P. A., Shepstone, L., Perez-Olivas, G., Melvin, C. L., Barnoux, M., Alexander, R., Roy, A., & Devapriam, J.Read research
This project sought to ascertain views and experiences of people with intellectual disabilities, their carers’, and specialist intellectual disability psychiatrists as to use of telepsychiatry consultations.
Gates, G., Sawhney, I., Alexander, R., Shardlow, S. & Zia, ARead research
Pharmacists have a critical role in monitoring the use of anticholinergic medication and preventing adverse effects on oral health.
Tharian, R. Patteril, E. & Shah, C.Read research
The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.
Tromans, S., Bhui, K., Sawhney, I., Odiyoor, M., Courtenay, K., Roy, A., Boer, H., Alexander, A., Biswas, A., McCarthy, J., Gulati, G., Laugharne, R., & Shankar, R.Read research