Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T05:50:07.712Z Has data issue: false hasContentIssue false

Chapter 15 - Autism

Published online by Cambridge University Press:  07 November 2024

By
Dolly Sud ,
Danielle Adams ,
Rohit Shankar  and
Samuel Tromans
Edited by
David M. L. Branford ,
Satheesh K. Gangadharan ,
Mary Barrett  and
Regi T. Alexander
David M. L. Branford
Affiliation:
Independent Pharmacy Consultant
Satheesh K. Gangadharan
Affiliation:
Leicestershire Partnership NHS Trust
Mary Barrett
Affiliation:
Leicestershire Partnership NHS Trust
Regi T. Alexander
Affiliation:
Hertfordshire Partnership University NHS Foundation Trust
Get access

Summary

Autism Spectrum Disorders (ASDs) are a group of severe developmental and neuropsychiatric disorders usually apparent by the age of three. Autism, referred to as autism spectrum disorder in the 11th revision of the International Classification of Diseases (ICD-11), is a neurodevelopmental condition characterised by persistent deficits in social interaction and social communication, as well as a range of restricted, repetitive behaviours (World Health Organization 2018). The onset of autism is in the developmental period (0–18 years of age), though for some autistic persons the symptoms may manifest later in life, at a time of increased social demands (World Health Organization 2018). In addition to the aforementioned core autistic features, many autistic people have associated symptoms, including hypo- or hypersensitivities to sensory stimuli, difficulties describing their emotional state (alexithymia), and problems with gross motor co-ordination The chapter will discuss the interface between autism spectrum disorder and intellectual disability and the potential management of the disorder. It will also cover the gender variations in presentation.

Keywords

challenging behaviourmental illnessrisperidonearipiprazolesocial interactionsocial communicationrestrictedrepetitive behavioursfluoxetine
Type
Chapter
Information
The Frith Prescribing Guidelines for People with Intellectual Disability , pp. 209 - 222
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Autism spectrum disorder in under 19s: Support and management. Clinical guideline [CG170] Published: 28 August 2013. Last updated: 14 June 2021 www.nice.org.uk/guidance/cg170/chapter/Recommendations.Google Scholar
Autism spectrum disorder in adults: diagnosis and management. Clinical guideline [CG142] Published: 27 June 2012. Last updated: 14 June 2021 www.nice.org.uk/guidance/cg142.Google Scholar
Cortese, S., Besag, F. M., Clark, B., et al. (2023). Common practical questions – and answers – at the British Association for Psychopharmacology child and adolescent psychopharmacology course. Journal of Psychopharmacology, 37(2), 119–34.CrossRefGoogle ScholarPubMed
Howes, O. D., Rogdaki, M., Findon, J. L., et al. (2018). Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. Journal of Psychopharmacology, 32(1), 3–29.CrossRefGoogle ScholarPubMed

References

Aishworiya, R., Valica, T., Hagerman, R., & Restrepo, B. (2022). An update on psychopharmacological treatment of autism spectrum disorder. Neurotherapeutics, 19(1), 248–62.CrossRefGoogle ScholarPubMed
Bai, D., Yip, B. H. K., Windham, G. C., et al. (2019). Association of genetic and environmental factors with autism in a 5-country cohort. JAMA Psychiatry, 76(10), 1035–43.CrossRefGoogle Scholar
Barrett, M., & Brugha, T. (2020). Autism spectrum disorder. In Bhaumik, S, and Alexander, R (eds.). Oxford Textbook of the Psychiatry of Intellectual Disability, Oxford University Press, 61–74.CrossRefGoogle Scholar
Baxter, A. J., Brugha, T. S., Erskine, H. E., et al. (2015). The epidemiology and global burden of autism spectrum disorders. Psychological Medicine, 45(3), 601–13.CrossRefGoogle ScholarPubMed
Beqiraj, L., Denne, L. D., Hastings, R. P., & Paris, A. (2022). Positive behavioural support for children and young people with developmental disabilities in special education settings: A systematic review. Journal of Applied Research in Intellectual Disabilities, 35(3), 719–35.CrossRefGoogle Scholar
Bhaumik, S., Tromans, S., Gumber, R., & Gangavati, S. (2020). Clinical assessment including bedside diagnosis. In Bhaumik, S. & Alexander, R. (Eds.), Oxford Textbook of the Psychiatry of Intellectual Disability. Oxford University Press, 7–22.CrossRefGoogle Scholar
Blanchard, A., Chihuri, S., DiGuiseppi, C. G., & Li, G. (2021). Risk of self-harm in children and adults with autism spectrum disorder: A systematic review and meta-analysis. JAMA Network Open, 4(10), e2130272.CrossRefGoogle ScholarPubMed
Brignell, A., Marraffa, C., Williams, K., & May, T. (2022). Memantine for autism spectrum disorder. Cochrane Database of Systematic Reviews, (8).Google ScholarPubMed
British National Formulary. (2023). Memantine hydrochloride. https://bnf.nice.org.uk/drugs/memantine-hydrochloride/#indications-and-dose.Google Scholar
Brugha, T. (2018). Approaches to treatment and care. In Brugha, T. (Ed.), The Psychiatry of Adult Autism and Asperger Syndrome. Oxford University Press, pp. 183–93.CrossRefGoogle Scholar
Brugha, T., Tyrer, F., Leaver, A., et al. (2020). Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population. International Journal of Methods in Psychiatric Research, e1814.CrossRefGoogle Scholar
Brugha, T. S. (2018). The Psychiatry of Adult Autism and Asperger Syndrome: A Practical guide. Oxford University Press.CrossRefGoogle Scholar
Brugha, T. S., Spiers, N., Bankart, J., et al. (2016). Epidemiology of autism in adults across age groups and ability levels. The British Journal of Psychiatry, 209(6), 498–503.CrossRefGoogle ScholarPubMed
Croen, L. A., Zerbo, O., Qian, Y., et al. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 814–23.CrossRefGoogle ScholarPubMed
Crompton, C. J., Ropar, D., Evans-Williams, C. V., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–12.CrossRefGoogle ScholarPubMed
Doyle, C. A., & McDougle, C. J. (2022). Pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience, 14(3), 263–79. https://doi.org/10.31887/DCNS.2012.14.3/cdoyle.Google Scholar
Dunn, K., Rydzewska, E., Macintyre, C., Rintoul, J., & Cooper, S. (2019). The prevalence and general health status of people with intellectual disabilities and autism co‐occurring together: A total population study. Journal of Intellectual Disability Research, 63(4), 277–85.CrossRefGoogle ScholarPubMed
Frith, U., & Happé, F. (1994). Autism: Beyond ‘theory of mind’. Cognition, 50(1–3), 115–32.CrossRefGoogle ScholarPubMed
Gates, J. A., Kang, E., & Lerner, M. D. (2017). Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis. Clinical Psychology Review, 52, 164–81.CrossRefGoogle ScholarPubMed
Giummarra, M. J., Randjelovic, I., & O’Brien, L. (2022). Interventions for social and community participation for adults with intellectual disability, psychosocial disability or on the autism spectrum: An umbrella systematic review. Frontiers in Rehabilitation Sciences, 3, 935473.CrossRefGoogle ScholarPubMed
Hassiotis, A., Poppe, M., Strydom, A., et al. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: Cluster randomised controlled trial. The British Journal of Psychiatry, 212(3), 161–8.CrossRefGoogle ScholarPubMed
Health Education England (2017). The key messages about Positive Behaviour Support www.hee.nhs.uk/sites/default/files/documents/The%20key%20messages%20about%20Positive%20Behaviour%20Support_0.pdf.Google Scholar
Hirsch, L. E., & Pringsheim, T. (2016). Aripiprazole for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, (6).CrossRefGoogle ScholarPubMed
Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: Definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics, 9(Suppl 1), S55.CrossRefGoogle ScholarPubMed
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4), 559–72.CrossRefGoogle ScholarPubMed
Jesner, O. S., Aref‐Adib, M., & Coren, E. (2007). Risperidone for autism spectrum disorder. Cochrane Database of Systematic Reviews, (1).Google Scholar
Lai, M., Anagnostou, E., Wiznitzer, M., Allison, C., & Baron-Cohen, S. (2020). Evidence-based support for autistic people across the lifespan: Maximising potential, minimising barriers, and optimising the person–environment fit. The Lancet Neurology, 19(5), 434—51.CrossRefGoogle ScholarPubMed
Lai, M., Kassee, C., Besney, R., et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819–29.CrossRefGoogle ScholarPubMed
Leaf, J. B., Cihon, J. H., Leaf, R., et al. (2022). Concerns about ABA-based intervention: An evaluation and recommendations. Journal of Autism and Developmental Disorders, 52(6), 2838–53.Google ScholarPubMed
Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 466–74.Google ScholarPubMed
Modabbernia, A., Velthorst, E., & Reichenberg, A. (2017). Environmental risk factors for autism: An evidence-based review of systematic reviews and meta-analyses. Molecular Autism, 8(1), 1–16.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2012). Autism spectrum disorder in adults: Diagnosis and management (CG142). www.nice.org.uk/guidance/cg142.Google Scholar
National Institute for Health and Care Excellence (2021). Autism spectrum disorder in under 19s: Support and management Clinical guideline [CG170]. https://www.nice.org.uk/guidance/cg170.Google Scholar
NHS England (2020). Stopping Over-Medication of People with a Learning Disability, Autism or Both. www.england.nhs.uk/wp-content/uploads/2017/07/stomp-gp-prescribing-v17.pdf.Google Scholar
NHS England (2023). Stopping over medication of people with a learning disability, autism or both (STOMP). https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/.Google Scholar
Pan, P., Bölte, S., Kaur, P., Jamil, S., & Jonsson, U. (2021). Neurological disorders in autism: A systematic review and meta-analysis. Autism, 25(3), 812–30.CrossRefGoogle ScholarPubMed
Posey, D. J., Kem, D. L., Swiezy, N. B., et al. (2004). A pilot study of D-cycloserine in subjects with autistic disorder. American Journal of Psychiatry, 161(11), 2115–17.CrossRefGoogle ScholarPubMed
Posserud, M., Skretting Solberg, B., Engeland, A., Haavik, J., & Klungsøyr, K. (2021). Male to female ratios in autism spectrum disorders by age, intellectual disability and attention‐deficit/hyperactivity disorder. Acta Psychiatrica Scandinavica, 144(6), 635–46.CrossRefGoogle ScholarPubMed
Potter, L. A., Scholze, D. A., Biag, H. M. B., et al. (2019). A randomized controlled trial of sertraline in young children with autism spectrum disorder. Frontiers in Psychiatry, 10, 810.CrossRefGoogle ScholarPubMed
Reddihough, D. S., Marraffa, C., Mouti, A., et al. (2019). Effect of fluoxetine on obsessive-compulsive behaviors in children and adolescents with autism spectrum disorders: A randomized clinical trial. JAMA, 322(16), 1561–9.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists. (2021). Stopping the overmedication of people with intellectual disability, autism or both (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP): Position Statement. www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/position-statement-ps0521-stomp-stamp.pdf?sfvrsn=684d09b3_6Google Scholar
Shankar, R., Wilcock, M., Oak, K., McGowan, P., & Sheehan, R. (2019). Stopping, rationalising or optimising antipsychotic drug treatment in people with intellectual disability and/or autism. Drug and Therapeutics Bulletin, 57(1), 10–13.CrossRefGoogle ScholarPubMed
Tromans, S., & Brugha, T. (2022). Autism epidemiology: Distinguishing between identification and prevalence. Progress in Neurology and Psychiatry, 26(1), 4–6.CrossRefGoogle Scholar
Tromans, S., Chester, V., Gemegah, E., et al. (2020). Autism identification across ethnic groups: a narrative review. Advances in Autism, 7(3), 41–255. https://doi.org/10.1108/AIA-03-2020-0017.Google Scholar
Tromans, S., Chester, V., Kapugama, C., et al. (2019). The PAAFID project: Exploring the perspectives of autism in adult females among intellectual disability healthcare professionals. Advances in Autism, 5(3), 157–70.CrossRefGoogle Scholar
Tromans, S., Chester, V., Kiani, R., Alexander, R., & Brugha, T. (2018). The prevalence of autism spectrum disorders in adult psychiatric inpatients: A systematic review. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 14, 177.CrossRefGoogle ScholarPubMed
Tromans, S., Stewart, Z., & Brugha, T. (2023). Autism: Social care, reasonable adjustments and the personal passport. BJPsych Advances, 29(5), 354–357.CrossRefGoogle Scholar
Walton, K. M., & Ingersoll, B. R. (2013). Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: A review of the literature. Journal of Autism and Developmental Disorders, 43, 594–615.CrossRefGoogle ScholarPubMed
Wei, H., Zhu, Y., Wang, T., et al. (2021). Genetic risk factors for autism-spectrum disorders: A systematic review based on systematic reviews and meta-analysis. Journal of Neural Transmission, 128, 717–34.CrossRefGoogle ScholarPubMed
Weld-Blundell, I., Shields, M., Devine, A., et al. (2021). Vocational interventions to improve employment participation of people with psychosocial disability, autism and/or intellectual disability: A systematic review. International Journal of Environmental Research and Public Health, 18(22), 12083.CrossRefGoogle ScholarPubMed
Whittenburg, H. N., Schall, C. M., Wehman, P., McDonough, J., & DuBois, T. (2020). Helping high school-aged military dependents with autism gain employment through project SEARCH ASD supports. Military Medicine, 185(Supplement_1), 663–8.CrossRefGoogle ScholarPubMed
Williams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. (2013). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, (8).Google Scholar
World Health Organization (2018). ICD-11 for Mortality and Morbidity Statistics. Geneva: World Health Organization.Google Scholar
Zafeiriou, D. I., Ververi, A., Dafoulis, V., Kalyva, E., & Vargiami, E. (2013). Autism spectrum disorders: The quest for genetic syndromes. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 162(4), 327–66.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×