Assessment of psychosis in ASD/ID: a case study

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.

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

“…In the current case, PAC, DASH-II, Kiddie-SADS, and clinical observation all proved helpful in identification of anxiety. Reports based on checklists completed by families and professional caregivers may vary according to their previous experience and knowledge regarding manifestations of psychiatric disorder in this population (Kildahl et al 2017). In line with previous suggestions (Appleton et al 2019, Valdovinos et al 2019, Helverschou et al 2011b, direct observation by mental health professionals with specific knowledge and experience concerning psychiatric disorder in ASD and ID may thus be particularly important as the diagnostic complexity increases, and was helpful also in the current study.…”

Identification of Post-Traumatic Stress Disorder in Individuals with Autism Spectrum Disorder and Intellectual Disability: A Systematic Review

“…Though there is no consensus regarding the use of standardized assessment tools not especially adapted to the group (Underwood et al, 2015), there are findings suggesting their usefulness when used by clinicians knowledgeable in ASD mental health issues (Kildahl, Bakken, Holm & Helverschou, 2017;Mehtar & Mukaddes, 2011;Hoover, 2015). However, when it comes to symptoms of a more intra-psychic nature, parental or carer report cannot fully replace self-report (Kildahl et al, 2017).…”

“…Though there is no consensus regarding the use of standardized assessment tools not especially adapted to the group (Underwood et al, 2015), there are findings suggesting their usefulness when used by clinicians knowledgeable in ASD mental health issues (Kildahl, Bakken, Holm & Helverschou, 2017;Mehtar & Mukaddes, 2011;Hoover, 2015). However, when it comes to symptoms of a more intra-psychic nature, parental or carer report cannot fully replace self-report (Kildahl et al, 2017). Though there have been recent, promising approaches (Hoover & Romero, 2019;Hall, Jobson & Langdon, 2014), there is currently a lack of appropriate self-report tools for individuals with ASD and ID for trauma exposure and PTSD symptoms.…”

“If we do not look for it, we do not see it”: Clinicians' experiences and understanding of identifying post‐traumatic stress disorder in adults with autism and intellectual disability

“…Psychiatric assessment in individuals with ASD and ID is generally challenging, requiring clinicians to have general knowledge of ASD and ID, general knowledge of mental health issues, as well as specific knowledge regarding the presentation of mental health problems in individuals with ASD and ID (Bakken, Helverschou, Høidal, & Martinsen, 2016; Helverschou, Bakken, & Martinsen, 2011; Kildahl, Bakken, Holm, & Helverschou, 2017; Maddox et al, 2019). However, many mental health providers lack knowledge and training in ASD and ID, and there have been reports of disconnects between the mental health and ASD/ID systems, limiting the access to mental health services for adults with ASD and/or ID (Bakken et al, 2018; Camm‐Crosbie, Bradley, Shaw, Baron‐Cohen, & Cassidy, 2019; Maddox et al, 2019; Whittle, Fisher, Reppermund, Lenroot, & Trollor, 2018).…”