Verity Chester and Peter E. Langdon
Social deficits are central within conceptualisations of autism spectrum disorder (ASD), and separately linked to offending behaviour. Social problem-solving interventions are…
Abstract
Purpose
Social deficits are central within conceptualisations of autism spectrum disorder (ASD), and separately linked to offending behaviour. Social problem-solving interventions are often used with offenders, but little research has examined the social information processing (SIP) skills of individuals with ASD and a history of criminal offending behaviours. The paper aims to discuss this issue.
Design/methodology/approach
This conceptual paper will introduce the SIP model, review SIP research as applied to those with ASD and in forensic populations, and further consider the relevance to the assessment and treatment of offenders with ASD.
Findings
Difficulties in all areas of the SIP model are noted in ASD and research suggests these difficulties may be directly linked to behaviour.
Practical implications
It is possible that identifying SIP abilities and deficits could improve the effectiveness of rehabilitation programmes for this group.
Originality/value
This paper reviews the utility of social information models in the offending behaviour of people with ASD.
Details
Keywords
Rahul Rai, Samuel Tromans, Chaya Kapugama, Verity Chester, Ignatius Gunaratna, Peter Langdon and Regi T. Alexander
The diagnosis of psychosis in individuals with autism spectrum disorder (ASD) poses a unique clinical challenge. The presence of intellectual disability (ID) further complicates…
Abstract
Purpose
The diagnosis of psychosis in individuals with autism spectrum disorder (ASD) poses a unique clinical challenge. The presence of intellectual disability (ID) further complicates the diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimises the duration of untreated psychotic symptoms and the subsequent impact on the quality of life of the patients concerned. The paper aims to discuss this issue.
Design/methodology/approach
The authors present four patients with psychosis, ASD and ID, who have received care within forensic mental health and ID settings. These examples demonstrate the interaction between these conditions, as well as issues pertaining to diagnosis and management.
Findings
In all four patients, sustained use of antipsychotic medication was objectively associated with an improvement in psychotic symptoms and quality of life. In instances where autistic phenomena were accentuated upon development of psychosis, such features returned to the baseline levels evident prior to the onset of psychosis.
Practical implications
The discussion and related case examples could improve the understanding of the possibility of psychosis in individuals with ASD and ID, and increase awareness of this diagnostic possibility among healthcare professionals.
Originality/value
This is the first published case series illustrating the challenges of diagnosing psychosis in individuals with ASD and ID.
Details
Keywords
Danielle Adams, Richard P. Hastings, Ian Maidment, Chetan Shah and Peter E. Langdon
Evidence of overprescribing of psychotropic medicines to manage challenging behaviour in people with intellectual disabilities has led to national programmes within the UK to…
Abstract
Purpose
Evidence of overprescribing of psychotropic medicines to manage challenging behaviour in people with intellectual disabilities has led to national programmes within the UK to promote deprescribing, such as stopping the overprescribing of medication in people (with learning disabilities, autism or both). To successfully implement deprescribing initiatives, we need to understand how to engage stakeholders in the process.
Design/methodology/approach
In a published systematic review, we reported evidence about the process of deprescribing psychotropic medicines for people of all ages with intellectual disabilities and challenging behaviour. As a part of the original review, we searched for evidence about stakeholders’ experiences of the psychotropic deprescribing process, which was synthesised and reported within the current study.
Findings
Six studies were identified. Involving carers and people with intellectual disabilities, providing ongoing support and improving access to non-pharmacological interventions, including positive behaviour support, may contribute to successful outcomes, including reducing or stopping psychotropic medicines and improving quality of life. Implementing psychotropic deprescribing requires a multidisciplinary collaborative care approach and education for stakeholders.
Originality/value
There have been no previous reviews of stakeholder experiences of deprescribing psychotropic medications for people with intellectual disabilities and challenging behaviour. The existing literature is scant, and further research is needed.
Details
Keywords
Regi Alexander, Peter E. Langdon, Verity Chester, Magali Barnoux, Ignatius Gunaratna and Sudeep Hoare
Individuals with diagnoses of autism spectrum disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between…
Abstract
Purpose
Individuals with diagnoses of autism spectrum disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. The paper aims to discuss these issues.
Design/methodology/approach
Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and intellectual disability settings.
Findings
The eight subtypes that are described draw on clinical variables including psychopathy, psychosis and intensity/frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter-rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree =0.90.
Practical implications
The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing.
Originality/value
This paper introduces a novel, typology-based approach which aims to better serve people with ASD within criminal justice settings.
Details
Keywords
– The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.
Abstract
Purpose
The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.
Design/methodology/approach
Drawing on the literature, as well as both clinical and research experience, some reasons are outlined for the lack of attention given to psychological therapies to treat depression amongst people with intellectual disabilities (IDs).
Findings
More research is needed, but existing evidence is promising regarding the effectiveness of adapted cognitive-behaviour therapy for depression amongst people with IDs.
Originality/value
The commentary draws attention to the scope for developing a range of effective cognitive, behavioural and cognitive-behavioural treatments.
Details
Keywords
Eddie Chaplin, Jane McCarthy, Samuel Tromans and Verity Chester
The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience…
Abstract
Purpose
The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.
Design/methodology/approach
A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.
Findings
Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.
Research limitations/implications
The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.
Practical implications
First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.
Social implications
To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.
Originality/value
The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.