Assessment and diagnosis of psychiatric disorder in adults with autism spectrum disorder

Published date07 September 2015
Date07 September 2015
AuthorLisa Underwood,Jane McCarthy,Eddie Chaplin,Marco O. Bertelli
Subject MatterHealth & social care,Learning & intellectual disabilities
Assessment and diagnosis of psychiatric
disorder in adults with autism
spectrum disorder
Lisa Underwood, Jane McCarthy, Eddie Chaplin and Marco O. Bertelli
Dr Lisa Underwood is based at
the University of Auckland,
Auckland, New Zealand and
Kings College London,
London, UK.
Dr Jane McCarthy is based at
the Kings College London,
London, UK and East London
NHS Foundation Trust,
London, UK.
Dr Eddie Chaplin is based at
the Kings College London,
London, UK and South London
and Maudsley NHS Foundation
Trust, London, UK.
Dr Marco O. Bertelli is Scientific
Director at CREA (Research
and Clinical Centre), San
Sebastiano Foundation,
Florence, Italy and EAMHID,
European Association for
Mental Health in Intellectual
Disability, Florence, Italy.
Purpose Adults with autism spectrum disorder (ASD) present with a range of psychiatric disorders.
However, making an accurate diagnosis is challenging. It is important to follow a robust and informed process
in the assessment of psychopathology that is centred on the individual and their neurodevelopmental
difficulties. The purpose of this paper is to provide clinicians with an evidence-based approach to the
assessment process for adults with ASD presenting with a possible co-occurrent psychiatric disorder.
Design/methodology/approach A review of the recent literature was undertaken focusing on key papers
that describe the assessment of mental health problems in adults with ASD.
Findings The presentation of psychiatric symptoms is influenced by the underlying developmental disorder
and it is often quite different from the one of the general population. Thus, it is essential to undertake a
comprehensive psychopathological assessment including a diagnostic assessment of ASD. There is a very
small evidence base on the use of diagnostic tools in the assessment of adults with ASD.
Originality/value This is a practice review paper applying recent evidence from the literature.
Keywords Autism, Assessment, Diagnosis, Intellectual disabilities, Autism spectrum disorder,
Psychiatric disorder
Paper type Literature review
It has become increasingly evident that adults with autism spectrum disorder (ASD) are at higher
risk of experiencing psychiatric disorders, particularly if they have an additional intellectual
disability (ID) (Bradley et al., 2014; Lai et al., 2013; Underwood et al., 2010). As in the general
population, the most common types of disorder presenting in adulthood are depression and
anxiety (Royal College of Psychiatrists, 2014). Schizophrenia, obsessive-compulsive disorder
(OCD), bipolar disorders, post-traumatic stress disorder (PTSD) and catatonia are also reported
in the literature (Kannabiran and McCarthy, 2009; Royal College of Psychiatrists, 2014).
There is evidence that the prevalence and presentation of mental health problems in adults
with ASD is atypical compared with the general population (Einfeld and Aman, 1995; Hutton
et al., 2008). This is thought to be due to complex relationships between a number of biological,
psychological and social factors (Cooper and Simpson, 2006; Ghaziuddin, 2005; La Malfa
et al., 2007). However, little is known about the aetiology and prognosis of mental health
problems in the context of ASD (Ruedrich, 2010). As such carrying out an assessment and
making a valid and reliable diagnosis are considerable challenges; diagnostic overshadowing
being a well-known complication (Kannabiran and McCarthy, 2009; Reiss et al., 1982).
Received 20 May 2015
Revised 20 May 2015
Accepted 9 July 2015
PAG E 22 2
VOL. 9 NO. 5 2015, pp. 222-229, © Emerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-05-2015-0025

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