Screening for autism spectrum disorder in adult psychiatric outpatients in a clinic in Taiwan

doi:10.1016/S0163-8343(03)00053-7

General Hospital Psychiatry

Volume 25, Issue 4, July–August 2003, Pages 284-288

https://doi.org/10.1016/S0163-8343(03)00053-7 Get rights and content

Abstract

Patients with adult autism spectrum disorder (ASD) continue to suffer from impairment in socialization and communication skills, and a proportion of them may develop psychiatric symptoms. It is thus likely that physicians in adult psychiatric departments may see a number of patients with ASD. Identification of patients with ASD is helpful and important for rehabilitation. This study estimated the prevalence of ASD among adult psychiatric outpatients in a Taiwanese medical center. A total of 660 patients were screened with Nylander and Gillberg’s “Autism Spectrum Disorder in Adult Screening Questionnaire.” Patients with high scores then underwent a diagnostic clinical interview conducted by child psychiatrists. Four patients (0.6%) were found to have ASD.

Introduction

When autism was first described, it was thought to be a single disease with a wide spectrum of presentations [1]. The etiology of autism is now considered mostly genetic, [2], [3] and available evidence suggests that genetic factors may be involved in many subjects diagnosed with Autism Spectrum Disorder (ASD) [4]. ASD, as defined by Gillberg, [5] includes autistic disorder, Asperger syndrome, disintegrative disorder, and other autisticlike conditions. However, the criteria of ASD for distinguishing subgroups tend to be arbitrary, and are difficult to apply clinically. Previous studies of children with ASD suggest that impairments in socialization and communication skills continue as these children enter adulthood [6], [7]. Moreover, a proportion of these children develop additional psychiatric symptoms and disorders in adolescence and adulthood [8]. It is thus likely that physicians at adult psychiatric outpatient clinics may see a number of patients with ASD whose disorder has not been recognized.

Although previous studies indicate that a small but significant number of such patients appear in adult psychiatric clinics, [9] variations remain in epidemiologic studies of adult ASD due to different diagnostic criteria and methodologic issues, including initial screening criteria. Similarly, although clinical services and special education for childhood autism were initiated more than 20 years ago in Taiwan, no data on the prevalence of adult ASD and its clinical pictures in adulthood have been published. This study intended to estimate the prevalence of ASD among adult psychiatric outpatients in a medical center and to evaluate the efficacy of Nylander and Gillberg’s “Autism Spectrum Disorder in Adult Screening Questionnaire” [9] (ASDASQ) in a Taiwanese (Han Chinese) population.

Section snippets

Target population

In Taiwan, patients may visit the psychiatric outpatient clinic without a referral from another physician. The target population in this study included patients treated at an adult walk-in psychiatric clinic at Chang Gung Memorial Hospital, Lin-Kuo Medical Center. Because these were walk-in patients, it was not known whether or not they had a psychiatric diagnosis. Ten general psychiatrists are responsible for this clinic, which serves approximately 5000 patients each month; approximately 100

Results

A total of 660 patients (374 men and 286 women) were screened with the questionnaires. The mean age of patients was 39.0±15.2 years (range 15 to 93 years). Distribution of age (birth year) is shown in Fig. 1. Initial psychiatric diagnoses according to DSM-IV are shown in Table 1.

Discussion

Of the 660 screened patients in this study, 1 patient was diagnosed as likely ASD and 4 patients (0.6%) as definite ASD. This number should be regarded as the minimum, as the exclusion criteria used in the chart review and patients with low ASDASQ scores were not interviewed. This might allow for some cases of ASD to be overlooked.

The prevalence of ASD, including childhood autism, Asperger’s syndrome, disintegrative disorder, and other autisticlike conditions is estimated to be at least 2.6 to

Acknowledgements

The author thank Ya-Wen Huang and In-Ru Wu for their administrative work during the preparation of this study.

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Although the co-occurrence of autistic spectrum disorder (ASD) and schizophrenia have been previously reported, the scope and magnitude of this comorbidity across large samples have not been sufficiently established. This study was aimed to assess the co-occurrence between schizophrenia and ASD in a large dataset, and to examine its predominance across different age and sex groups. Schizophrenia patients and age and sex frequency controls (n = 49,334) were assessed for the prevalence of autism spectrum disorder. The sample was stratified by age and sex, and co-occurrence was assessed using univariate and multivariate logistic regressions. Results indicated that schizophrenia was associated with ASD (OR = 7.01, 95%CI 2.98–16.43, p < .0001) across all age groups aside from 50 to 70 years. This association was significant among male participants (OR = 11.69, 95%CI 3.59–38.01, p < .0001) but not among female participants (OR = 2.33, 95%CI 0.60–9.03, p = .21). These findings indicate a large overlap between schizophrenia and ASD, and point to the need to expand the understanding of the potential mediating mechanisms of this co-occurrence.
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The present study aimed to examine the reliability and validity of the Italian version of the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), a screening tool for autism spectrum disorder (ASD) among psychiatric outpatients.
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Our findings suggest that the ASDASQ, in the Italian adaptation, may be considered a quick, simple, and effective tool to screen for ASD among psychiatric outpatients. Further studies are needed to evaluate its utility in other clinical settings.
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Likewise, there has been a scarcity of research on ASD screening tools in adult populations. Some studies have shown that ASD can be diagnosed in adult psychiatric outpatients who had no prior clinical ASD diagnosis (Chang et al., 2003; Nylander & Gillberg, 2001). Furthermore, a study using a community sample in England detected ASD in 9.8 per 1000 adults (Brugha et al., 2011).
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Electronic databases, including MEDLINE, EMBASE, PsychINFO, Cochrane Library and CINAHL, were searched through March 2017. Studies examining the validity of ASD screening tools against the Autism Diagnostic Observation Schedule and/or the Autism Diagnostic Interview - Revised in non-young children (age 4 or above) and adults were included. Three authors independently reviewed each article for data extraction and quality assessment.
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As ASD is a developmental disorder which by definition is present from early childhood, it is essential to consider an individual's development history in order to discriminate between true ASD and ALTs which may currently map onto diagnostic criteria. Four of the six studies reporting on ASD diagnosis utilised developmental history to inform diagnosis via interviews with parents or family members known to the participant during childhood (Waris et al., 2013; Mandell et al., 2012; Hallerback et al., 2012; Fraser et al., 2012); however, both Davidson et al. (2014) and Chang et al. (2003) sought historical information from family members where possible. Reliance on retrospective information from family members has advantages in that they are likely to have the best knowledge of their child however it also has drawbacks which include the potential influence of recall bias.
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Commentary and perspectiveScreening for autism spectrum disorder in adult psychiatric outpatients in a clinic in Taiwan

Abstract

Introduction

Section snippets

Target population

Results

Discussion

Acknowledgements

Am J Human Genetics

Am J Human Genetics

Am J Human Genetics

J Am Acad Child Adolesc Psychiatry

Problems of nosology and psychodynamics of early infantile autism

Am J Orthopsychiatry

Autism and pervasive developmental disorder

J Child Psycho Psychiatry

Factors related to outcome in autistic children

J Autism Childhood Schizo

Outcome and prognostic factors in infantile autism and similar conditionsa population-based study of 46 cases followed through puberty

J Autism Dev Dis

Commentary and perspective
Screening for autism spectrum disorder in adult psychiatric outpatients in a clinic in Taiwan