Prevalence and correlates of autism in a state psychiatric hospital

Abstract

This study estimated the ASD prevalence in a psychiatric hospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic (ROC) curves were used to evaluate the SRS as a screening instrument. Chi-squared Automatic Interaction Detector (CHAID) analysis estimated the role of other variables, in combination with the SRS, in separating cases and non-cases. Ten percent of the sample had ASD. More than other patients, their onset was prior to 12 years of age, they had gait problems and intellectual disability, and were less likely to have a history of criminal involvement or substance abuse. Sensitivity (0.86) and specificity (0.60) of the SRS were maximized at a score of 84. Adding age of onset < 12 years and cigarette use among those with SRS <80 increased sensitivity to 1.00 without lowering specificity. Adding a history substance abuse among those with SRS >80 increased specificity to 0.90 but dropped sensitivity to 0.79. Undiagnosed ASD may be common in psychiatric hospitals. The SRS, combined with other information, may discriminate well between ASD and other disorders.

The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions

“…Undiagnosed ASD may be common in outpatient CMHC programs, similar to inpatient psychiatric hospitals (Mandell et al, 2012). Of the four adults with ASD who did not have a prior formal ASD diagnosis, three had mentions of possible “autism,” “pervasive developmental disorder (PDD),” or a similar term in their charts.…”

“…In addition, an ASD diagnosis requires that symptoms be present from early childhood, but it is often difficult to find family members or caregivers who can provide details about this early time period for adults. These challenges have resulted in many adults with ASD remaining undiagnosed, experiencing unmet service and treatment needs (Garland, O’Rourke, & Robertson, 2013; Mandell et al, 2012). In order to provide appropriate services for adults with ASD, clinicians need tools that accurately distinguish ASD from other psychiatric disorders in adulthood.…”

The Prevalence of Autism Spectrum Disorders in Adult Psychiatric Inpatients: A Systematic Review

“…Publication dates for such studies ranged from 1982 to 2012, and all were conducted in England or North America. The characteristics of the study samples varied markedly, including both state [9] and secure psychiatric hospitals [22, 23], as well as long-stay treatment facilities for individuals with ID [24]. Limited data were available on the mean age for many included studies (though all were conducted on adult populations), with mean age ranging from 42 to 52 years.…”

“…Mandell et al [9] (2012) cited several reasons to support the suggestion that ASD may be overrepresented and underdiagnosed among adults within such a setting, including a lack of training among adult psychiatrists in conditions originating in childhood. Additionally, presence of comorbid psychiatric disorders that are more common in people with ASD could potentially complicate the diagnostic picture [9, 10], including depression [11, 12], bipolar disorder [13], anxiety disorders [14], schizophrenia [13, 15], attention deficit hyperactivity disorder [11, 14], alcohol and substance abuse [13], as well as ID [16, 17]. Such conditions could lead to instances of failure to identify ASD where present, as well as misattribution of ASD symptoms to other forms of mental disorder, such as schizophrenia [9, 15].…”

“…Such conditions could lead to instances of failure to identify ASD where present, as well as misattribution of ASD symptoms to other forms of mental disorder, such as schizophrenia [9, 15]. Finally, the diagnostic criteria for ASD have broadened in recent decades, in contrast to the narrowing of those for schizophrenia [9, 18-20]. …”