Michelle Heyman, Megan Ledoux Galligan, Giselle Berenice Salinas, Elizabeth Baker, Jan Blacher and Katherine Stavropoulos
Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are appropriate…
Abstract
Purpose
Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are appropriate. Differentiating among neurodevelopmental disorders such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder and intellectual disability can be a complex process, especially, as these disorders have some overlapping symptoms and often co-occur in young children. This series of case studies aims to present commonly overlapping symptoms in children who present to clinics with developmental concerns.
Design/methodology/approach
This paper presents three case studies that were completed at a free community ASD screening clinic in Southern California.
Findings
The case studies have common presenting behaviors and symptoms (e.g. social communication difficulties) that often co-occur across diagnoses; explanations for the final diagnoses are given in each case.
Research limitations/implications
Conclusions from these three cases cannot generalize to all children being seen in clinics for neurodevelopmental concerns.
Practical implications
This series of case studies highlights commonly overlapping symptoms in children who present for differential diagnosis with social and/or behavioral concerns. Implications for educational placement and intervention are discussed.
Social implications
These cases highlight the challenges involved in the differential and dual diagnostic process for young children with developmental concerns. Diagnostic considerations can affect later educational placement and opportunities for socialization.
Originality/value
This series of case studies provide practical information for clinicians about how to effectively differentiate between commonly occurring neurodevelopmental disorders, particularly given recent changes to the Diagnostic and Statistical Manual, 5th edition (DSM-5).
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Ann Marie Martin, Katherine Stavropoulos and Jan Blacher
Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of…
Abstract
Purpose
Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.
Design/methodology/approach
Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.
Findings
The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.
Originality/value
More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.
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Jan Blacher, Bonnie Kraemer and Erica Howell
The differential impact of young adult diagnosis on families during the period of transition from school to adult life was examined. Participants were parents of 246 young adults…
Abstract
The differential impact of young adult diagnosis on families during the period of transition from school to adult life was examined. Participants were parents of 246 young adults with severe learning disability aged 18‐26. Young adults were classified into four diagnostic groups: autism (N = 30), Down's syndrome (N = 68), cerebral palsy (N = 95) and an undifferentiated learning disability group (N = 53). Research questions pertained to parent expectations about their young adults' transition to living and working environments post high school. Parental satisfaction and worries were also assessed. The results indicated more community expectations of work for young adults with Down's syndrome, and more restrictive expectations for young adults with autism, including more expectations that young adults with autism would move out of the family home into a residential environment. Parents of young adults with autism also worried significantly more about various aspects of transition than other parent groups.
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Carrie L. Shandra and Fiona Burke
How people spend their time is an indicator of how they live their lives, with time use over the life course conditioned both by age and by participation in age-graded…
Abstract
How people spend their time is an indicator of how they live their lives, with time use over the life course conditioned both by age and by participation in age-graded institutions. This chapter uses nationally representative data from the pooled 2008–2020 American Time Use Survey (ATUS) to evaluate how time use in 12 activity categories varies by age, gender, and disability status among 137,266 respondents aged 15 and older. By doing so, we quantify the “disability gap” in time use between men and women with and without disabilities, identifying at what age and by how much people with disabilities experience time differentials in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and other indicators of social participation. Results indicate that – at many ages – patterns of time use for people with disabilities deviate from those of people without disabilities, with more pronounced differences in midlife. Further, the magnitude of women's disability gaps equals or exceeds men's for sleeping, and nearly all ADLs and IADLs, indicating that disability gaps are also gendered.
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Jonny Hartley, Jack Purrington and Gemma Hartley
The COVID-19 pandemic has resulted in health services adapting the delivery of routine assessments, with many operating remotely. This paper aims to explore the lived experiences…
Abstract
Purpose
The COVID-19 pandemic has resulted in health services adapting the delivery of routine assessments, with many operating remotely. This paper aims to explore the lived experiences of individuals undertaking remote autism assessments during the COVID-19 pandemic.
Design/methodology/approach
A mixed-methods service evaluation was completed in an adult autism and neurodevelopmental service based in the north of England. A total of 24 participants, who had undergone remote autism assessments between March 2020 and July 2020, completed a questionnaire about their experiences. Thematic analysis was performed, and additional quantitative data were analysed descriptively to allow contextual information to be included.
Findings
The evaluation identified three main themes. The first, practical and sensory issues of remote assessment, indicated that internet connectivity problems were common and sometimes impeded a successful assessment. Additionally, participants identified some elements of the videocall impacted their sensory sensitivities. The second theme, emotional responses to remote assessment, demonstrated relief and exhaustion to be common following sessions. The ability to complete assessments from a safe space were favoured by most. The final theme, pros and cons of different assessment methods, highlighted the preference for video assessments above telephone and in person sessions.
Originality/value
This study provides an original contribution to the literature by gathering autistic adults’ perspectives on remote autism assessments. The findings suggest that video assessments were the most preferable, over face-to-face and then telephone. Services should offer video and face-to-face assessments while keeping telephone assessments to a minimum.
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Bethany Driver and Verity Chester
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…
Abstract
Purpose
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.
Design/methodology/approach
This paper aims to report a narrative literature review that examines research on the presentation, recognition, and diagnosis of autistic women and girls.
Findings
Findings suggest that autistic females present differently to males and highlight low recognition of the female presentation of autism among the general public, in social spheres, educational, clinical and forensic settings. This lack of recognition appears to affect the likelihood of females being referred for diagnosis, the reliability of diagnostic assessments and subsequent access to support.
Originality/value
Recommendations for clinical practice focus on initiatives to increase awareness of the female presentation of autism, improving the diagnostic process for females, increasing female representation within autism training and for future research to support these goals.