Assessment of psychosis in ASD/ID: a case study

DOIhttps://doi.org/10.1108/AMHID-11-2016-0036
Published date03 January 2017
Date03 January 2017
Pages17-23
AuthorArvid Nikolai Kildahl,Trine Lise Bakken,Olaf Kristian Holm,Sissel Berge Helverschou
Subject MatterHealth & social care,Learning & intellectual disabilities
Assessment of psychosis in ASD/ID:
a case study
Arvid Nikolai Kildahl, Trine Lise Bakken, Olaf Kristian Holm and Sissel Berge Helverschou
Abstract
Purpose Assessment of psychiatric disorders in people with autism spectrum disorder (ASD) and
intellectual disabilities (ID) is challenging. The purpose of this paper is to explore the diagnostic decision
making and strategies employed in the assessment of a young man with ASD and ID who eventually got the
additional diagnosis of schizophrenia.
Design/methodology/approach To describe and explore a process not easily converted into quantitative
measures, it was chosen to perform a case study of a single case.
Findings The combined knowledge of ASD, ID and psychiatric disorder was important in the current
assessment. General assessment tools were of some value, but their results had to be interpreted with
care. The same was true of a mor e ASD/ID-specific tool . Using multiple informer s may strengthen data
from such tools in this popu lation, but does not make it i nterchangeable with sel f-report. The case
presented demonstra tes the possibility of ne gative symptoms and func tional decline oversha dowing
positive psychotic sym ptoms in people with ASD/ID , as well as the expression of ASD c hanging with a
functional decline.
Originality/value The present study adds to the few previous reports on identification of psychosis in this
population, and in addition, may assist clinicians in making more accurate psychiatric assessments of people
with ASD/ID.
Keywords Assessment, Intellectual disabilities, Psychosis, Schizophrenia, Autism spectrum disorder,
Psychiatric disorder
Paper type Case study
Introduction
The identification of psychiatric disorder in people with autism spectrum disorder (ASD) and
intellectual disability (ID) poses considerable challenges, such as: there are few appropriate
assessment tools; symptoms of ASD may be difficult to separate from symptoms of psychiatric
disorder;and people withASD and ID usuallyhave difficultiesin self-report(Helverschouet al., 2011;
Underwood et al., 2015). Differentiating ASD and psychosis seems to be particularly challenging
(Bertelli et al., 2015; Bakken and Høidal, 2014).
Psychiatric symptoms in individuals with ASD may be similar to symptoms in the general
population or they may present in ways that are unusual in the general population, but common
to people with ASD (Helverschou et al., 2011; Underwood et al., 2015). The latter includes an
apparent increase of, or change in, ASD symptoms (Ghaziuddin, 2005; Underwood et al., 2015),
as well as increase in challenging behavior (Helverschou and Martinsen, 2011; van Steensel
et al., 2011). Some individuals with ASD have idiosyncratic (i.e. particular for one individual) ways
of communicating and behaving, which also affect symptoms of psychiatric disorder
(Ghaziuddin, 2005; Hutton et al., 2008). Symptoms of psychiatric disorder may also be
related to the individuals level of intellectual functioning (ID) (Helverschou et al., 2011; Myrbakk
and von Tetzchner, 2008) and age and verbal skills (Ghaziuddin, 2005; Helverschou et al., 2011;
Karim et al., 2014). For psychotic disorder in people with ASD/ID, disorganized behavior has
been described as possibly being conceptually equivalent to disorganized thought or speech in
people without developmental disabilities (Bakken et al., 2007, 2009).
Received 18 November 2016
Revised 21 February 2017
Accepted 3 April 2017
Arvid Nikolai Kildahl is a
Specialist in Clinical
Psychology and
Trine Lise Bakken is a
Researcher, both at the
Regional Section Mental
Health, Intellectual Disabilities/
Autism, Oslo University
Hospital, Oslo, Norway.
Olaf Kristian Holm is based at
the Habilitation Centre, Molde,
Møre og Romsdal Hospital
Trust, Molde, Norway.
Sissel Berge Helverschou is
based at the NevSom
Norwegian Centre of Expertise
for Neurodevelopmental
Disorders and Hypersomnias,
Oslo University Hospital, Oslo,
Norway.
DOI 10.1108/AMHID-11-2016-0036 VOL. 11 NO. 1 2017, pp.17-23, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE17

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