Adults with Autism Spectrum Disorders using psychiatric hospitals in Ontario: Clinical profile and service needs

Surrey Place Centre, Canada
Research in Autism Spectrum Disorders (Impact Factor: 2.96). 10/2009; 3(4):1006-1013. DOI: 10.1016/j.rasd.2009.06.005


BackgroundAdults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual disabilities (ID).MethodA secondary analysis of data from the 2003 Comprehensive Assessment Projects from three psychiatric hospitals in Ontario was conducted to describe patients with ASD and ID and to determine how their profile compared to other hospital users.ResultsTwenty-three patients with ASD and ID were matched on gender and patient status (inpatient/outpatient) to individuals with and without ID. Individuals with ASD and ID were similar in terms of demographics to patients with and without ID. However, individuals with ASD and ID were younger, spent more days in hospital and were less likely to have a psychotic disorder diagnosis than both patients with and without ID. Inpatients with ASD and ID were recommended for a higher level of care than hospital service users without ID.ConclusionsClearly, this small sub-group of individuals within the hospital population has high clinical needs that are not always well met.

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    • "Differential diagnosis is particularly challenging for those psychiatrists who have not had specific training on psychiatric phenomenology in adults with neurodevelopmental disorders (Bradley et al., 2011b; Hurley et al., 2003; Lunsky et al., 2008, 2009). "
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    ABSTRACT: Purpose – During the last few years the prevalence of autism and Autism Spectrum Disorder (ASD) has increased greatly. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. The purpose of this paper is to define the boundaries and overlapping clinical characteristics of IDD, ASD and SSD; highlight the most relevant differences in clinical presentation; and provide a clinical framework within which to recognize the impact of IDD and ASD in the diagnosis of SSD. Design/methodology/approach – A systematic mapping of the international literature was conducted on the basis of the following questions: first, what are considered to be core and overlapping aspects of IDD, ASD and SSD; second, what are the main issues in clinical practice; and third, can key diagnostic flags be identified to assist in differentiating between the three diagnostic categories? Findings – Crucial clinical aspects for the differentiation resulted to be age of onset, interest towards others, main positive symptoms, and anatomical anomalies of the central nervous system. More robust diagnostic criteria and semeiological references are desirable. Originality/value – The present literature mapping provides a comprehensive description of the most relevant differences in the clinical presentation of ASD and SSD in persons with IDD.
    No preview · Article · Sep 2015
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    • "Peacock et al. (2012) found that 47 % of children with ASD had at least one selected co-occurring condition, with attention deficit/hyperactivity disorder (ADHD) the most common, at 30 %. Children with ASD and intellectual disability (ID) incurred expenditures 2.7 times higher than did children with ASD and no co-occurring conditions. Lunsky et al. (2009) reported that inpatients with ASD and ID were recommended for a higher level of care than hospital service users without ID. However, the families of children diagnosed with ASD comorbid with ADHD or ID reported the highest levels of dissatisfaction across all health care quality variables and reported the greatest impact on the family's financial situation (Zablotsky et al. 2014). "
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    ABSTRACT: This paper aims to examine health care utilization and expenditure in the provision of medical care to understand the medical care burden of children with autism spectrum disorders based on recent literature reviews. This article reviews the recent literature in Medline, PubMed, and Google by using key terms that are relevant to autism spectrum disorder (ASD) and health care (medical care) utilization, medical care costs, and expenditures. I also hand-searched the reference lists of all of the included articles and recent narrative and systematic reviews related to medical care utilization and the costs of ASD to identify potentially relevant articles. The literature on medical care utilization and expenditures related to ASD highlights the fact that the disorder imposes high medical care burdens on families and on society. It is necessary to initiate appropriate, comprehensive, and accessible medical care services for individuals with ASD, particularly for those with comorbid conditions. Future studies should examine the impact of such improvements in the management of children with ASD on medical care utilization and costs.
    Preview · Article · Jun 2014
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    • "Extensive information exists on the mental health needs and the prevalence of specific mental illnesses among persons with DD from the United States and several European countries (e.g., [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]). However, the literature on the mental health needs of persons with DD in Canada remains very limited [16] [17] [18] [19] [20] [21] [22] [23] [24] [25]. Most Canadian research has focused on hospitalizations for mental health or psychiatric disorders [16, 17, 19–21, 23–25] and has centered on the Canadian province of Ontario [19–21, 23–25]. "
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    ABSTRACT: Study Objective. To estimate and compare the prevalence of dementia and depression among adults with and without developmental disabilities (DDs). Methods. We linked data from several provincial administrative databases to identify persons with DDs. We matched cases with DD with persons without DD as to sex, age, and place of residence. We estimated the prevalence of dementia and depression and compared the two groups using the Generalized Estimating Equations (GEEs) technique. Results. The estimated prevalence of depression and dementia among younger adults (20-54) and older adults (50+) with DD was significantly higher than the estimated rates for the matched non-DD group (Depression: younger adults: RR = 2.96 (95% CI 2.59-3.39); older adults: RR = 2.65 (95% CI 1.84-3.81)), (Dementia: younger adults: RR = 4.01 (95% CI 2.72-5.92); older adults: RR = 4.80 (95% CI 2.48-9.31)). Conclusion. Significant disparities exist in mental health between persons with and without DDs.
    Full-text · Article · Aug 2011
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