ADULTS WITH ASD ISSUES AND CHALLENGES.

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ADULTS WITH ASD- ISSUES AND CHALLENGES.

• RESEARCH AUTISM FORUM, NOVEMBER 2006

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• 1. Outcome in adulthood
• 2 Evidence of deterioration in adulthood?
• 3. Psychiatric problems

• 4. Forensic problems
• 5. How can we improve outcome

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1. General Outcome

• Findings variable but
• Outcome poorest in
• individuals of lower IQ (lt50)
• no useful language by 5-6 years
• greater no. of symptoms in childhood
• females
• those with epilepsy

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Maudsley study- (Howlin, Goode, Hutton Rutter,
2004)
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2. Deterioration in adulthood?

• Follow-up studies indicate differing rates - from
  lt10 to gt30 of subjects showing an increase in
  problems over time
• hyperactivity, aggression, destructiveness,
  rituals, inertia, loss of language and slow
  intellectual decline

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Maudsley follow-up

• 16 definite new disorder in adulthood
• ( ?6 new disorder)
• 5 OCD
• 15 affective disorder (8 with obsessional
  features)
• 1 bipolar
• 1 acute anxiety

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• Deterioration most marked in
• individuals of lower verbal IQ
• those in long-stay hospitals
• and ? those with epilepsy

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BUT

• Most follow-up studies note that
• 30- gt40 show many improvements in
• late adolescence/early adulthood
• Over time
• Decreases in ADI symptomatology- social,
  communication and rituals/obsessions even in
  most intellectually impaired

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3. Mental health problems in adulthood
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Studies in children

• Brereton et al.(2006) 380 consecutive referrals
  age 4-24
• 61 clinical levels of psychopathology
• 9 anxiety disorders
• Leyfer et al., 2006. 109 children age 5-17 yrs
  IQgt60. Consecutive referrals
• 24 mood disorders (including generalised
  anxiety)
• 52 phobias
• 37 OCD
• 0 schizophrenia/other psychosis

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Adults with autism case studies of psychiatric
diagnoses (N200)
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Summary

• No evidence of increased rates of schizophrenia
• Affective illness most common type of problem
• Often become worse in late adolescence/early
  adulthood
• May have delusional content associated with
  autistic obsessions
• Obsessional compulsive disorders may be difficult
  to distinguish from autistic-type rituals

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Incorrect diagnoses occur because

• Many adult psychiatrists know little about
  developmental disorders (or mental retardation)
• Misinterpret symptoms due to patients
• inappropriate emotional responses
• inappropriate verbal responses
• unusual ways of describing symptoms
• Leading to incorrect conclusions and treatment

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4 Forensic problems
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Examples of behaviours leading to problems with
police

• Fascination with
• poisons chemicals guns certain types of
  clothing washing machines trains cars
• Fire setting (or fire engines)
• Particular dislikes (babies noise)
• Sexual offences - tend to be associated with
  obsessions or lack of social understanding.
• Very occasionally, cases of apparently
  unexplained violence

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Incorrect to base conclusions about incidence
either on

• Single cases
• Atypical samples (e.g. Special hospital
  population)
• Anecdotal accounts/newspaper reports with no
  confirmed diagnosis
• Review by Ghaziuddin et al rates much lower than
  average (violent crime rate 7 of 20-24 yr males
  in US)

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However

• If problems do occur can be very difficult to
  resolve because of
• Lack of awareness of
• social impact
• implications for self
• potential for harm
• Rigidity of beliefs
• Obsessionality

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• Adult problems often related to childhood
  preoccupations/routines
• Need to ensure that behaviours that are
  acceptable for a small child do not persist into
  adulthood
• May be due to desire for friendship
• May be mistaken interpretation of cues
• More likely to be victims, not perpetrators of
  crime

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5. What will happen when parents are no longer
around?
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Residential status Maudsley study
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6. Growing old

• ????

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7. How can outcome be improved?
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Reduce factors likely to cause problems in
adulthood

• Indications from some research (eg Lord Venter,
  1992) that extrinsic factors - ie support
  networks- may be just as important as individual
  variables

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Address factors leading to psychiatric and
forensic problems

• Lack of structure predictability
• Boredom ( gtroutines rituals)
• Low self esteem isolation from peer group
• Continuation of childhood behaviours that become
  unacceptable with age
• Improve understanding and knowledge of mental
  health professionals

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Make use of existing skills to

• Encourage social contacts
• Increase social status
• Enhance self esteem
• Oddness may be tolerated/forgiven if compensated
  for by other skills

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Creating an autism friendly environment

• Autism aware
• necessity of visual cues
• disparity between verbal expression and
  comprehension
• importance of routines
• limitations of choice decision making

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Creating an autism friendly environment

• Unconventional
• Controllable
• Predictable
• Consistent

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• Improve opportunities for social inclusion
• Especially for work!

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Prospects Jobs found from 1995-2003(Total 203)
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Types of job
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• Improve recognition by social, health and
  employment services of needs of adults with
  autism (especially those who are more able)
• Improve options for supported and
  semi/independent living removing pressure on
  parents
• Seek better ways of improving social interactions
  (social skills groups befriending schemes)
• Provide for emotional needs especially of more
  able individuals