Background Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post‐traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co‐occurring ASD and ID. Method Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. Results Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. Conclusions Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma‐related symptoms in this population.

Introduction Autism Spectrum Disorder (ASD) and Intellectual Disability (ID) seem to influence risk of and vulnerability to exposure to trauma and adverse events. While assessment of psychiatric disorder in ASD and ID generally is challenging, identification of Post-traumatic stress disorder (PTSD) seems particularly so, and knowledge does not seem easily accessible. Methods This article provides a systematic review of studies describing trauma reactions in individuals with both ASD and ID, including studies involving any single case with the combination of 3 ASD, ID, and PTSD. To systematically explore PTSD symptom presentation in the group, all reported symptoms from studies were assigned by DSM 5 criteria. Results Eighteen studies met the inclusion criteria, eight group studies and ten case studies. Assessment methodology in studies varied, as did the format of symptom report. DSM 5 criteria provided a useful framework for integrating findings across studies, indicating that PTSD may be identified in individuals with ASD and ID. However, symptoms involving alterations in arousal and negative alterations in thought and behavior seem more easily identified than symptoms of re-experiencing and avoidance. Conclusions There is an urgent need to identify behavioral equivalents to PTSD symptoms in this group, making it possible to identify warning signs of trauma and abuse even if such incidents are not known to family or professional carers.

Background The identification and treatment of psychiatric disorders in individuals with autism spectrum disorders (ASD) and ID presents many challenges. We describe the development of a professional network, together with a standardized protocol for clinical assessment, designed to promote clinical competence and professional development in eight clinical centers responsible for providing mental health services to autistic individuals with ID across all four health regions of Norway. Specific aims to describe: (1) patterns of psychiatric and behavior problems in patients treated by the network, (2) patterns of change over time, and (3) the relationship between psychiatric disorders and behavior problems. Method A standardized protocol was used to assess individual progress in 132 patients (inpatients and outpatients) with autism and ID over 2 years (at referral (T1), after 1 year (T2), and after 2 years (T3)). Changes in psychiatric symptoms and behavior problems were assessed with the Psychopathology in Autism Checklist (PAC) and Aberrant Behavior Checklist (ABC). Results Patients showed significant (p < .001) improvements from T1 to T2 on the psychosis, depression and anxiety subscales of the PAC, but no significant improvement on the obsessive compulsive disorder (OCD) subscale. Improvements were maintained from T2 to T3. Patients showed significant (p < .01) improvements on the ABC total score and on all ABC subscales except inappropriate speech from T1 to T2; these improvements were maintained from T2 to T3. Discussion The combination of a professional network and a standardized protocol for clinical assessment has promise as a strategy for improving professional competence and facilitating specialized mental health services for autistic individuals with ID and psychiatric disorders across an extensive geographical area.

Introduction: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) seem to be at increased risk for post-traumatic stress disorder (PTSD), but knowledge is sparse regarding its identification in this population. Previous research indicates that certain symptoms of PTSD may be more easily recognized, and that identifying reexperiencing and avoidance is particularly challenging. Methods: Interpretative phenomenological analysis was used to explore 18 experienced clinicians' perceptions of PTSD symptom expression in ASD and ID through individual, qualitative interviews. Results:Informants provided examples from all symptom groups, but these differed in how frequently they were described. Recognition of reexperiencing may rely on knowledge about individuals' trauma experience. Avoidance may present in a wider range of ways. Conclusion: Development of reexperiencing and avoidance may follow different trajectories in this population, contributing to challenges in recognition. Reexperiencing may be more severe in ASD/ID. Implications are discussed in light of current diagnostic criteria.

Purpose -The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities. Design/methodology/approach -The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five patients all met criteria for PTSD according to the Diagnostic Manual -Intellectual Disability. Findings -Previously, it was not suspected that the five patients suffered from PTSD, although they had experienced terrifying incidents. All patients displayed severe changes in behaviour, which may have overshadowed symptoms of PTSD. PTSD in persons with more severe intellectual disabilities may be interpreted as challenging behaviour, or other psychiatric disorders such as psychosis.Research limitations/implications -The limitation of the study is the small number of participants. Practical implications -Practical implication is linked to clinical practice related to identification of PTSD in persons with intellectual disabilities. Originality/value -The paper may encourage more research into how PTSD can be identified in persons with moderate and severe intellectual disabilities. The case reports may help clinicians to look for traumatic experiences in persons with intellectual disabilities who have experienced terrifying incidents.

No abstract

Purpose Assessment of psychiatric disorders in people with autism spectrum disorder (ASD) and intellectual disabilities (ID) is challenging. The purpose of this paper is to explore the diagnostic decision making and strategies employed in the assessment of a young man with ASD and ID who eventually got the additional diagnosis of schizophrenia. Design/methodology/approach To describe and explore a process not easily converted into quantitative measures, it was chosen to perform a case study of a single case. Findings The combined knowledge of ASD, ID and psychiatric disorder was important in the current assessment. General assessment tools were of some value, but their results had to be interpreted with care. The same was true of a more ASD/ID-specific tool. Using multiple informers may strengthen data from such tools in this population, but does not make it interchangeable with self-report. The case presented demonstrates the possibility of negative symptoms and functional decline overshadowing positive psychotic symptoms in people with ASD/ID, as well as the expression of ASD changing with a functional decline. Originality/value The present study adds to the few previous reports on identification of psychosis in this population, and in addition, may assist clinicians in making more accurate psychiatric assessments of people with ASD/ID.

No abstract