Article

Autismus bei erwachsenen Menschen mit geistiger Behinderung

Der Nervenarzt (Impact Factor: 0.79). 11/2010; 81(11):1333-1345. DOI: 10.1007/s00115-010-3098-1

ABSTRACT

According to the World Health Organization (WHO) the estimated prevalence of intellectual disabilities (ID) is about 1–3% and 1 out of 4 individuals with ID suffer from an additional autistic spectrum disorder (ASD) (arithmetic mean 24.6%, 19 studies, n=9,675) whereby the prevalence increases with the severity of ID (IQ 50–70: 9.9%, IQ<50: 31.7%). Therefore, it is of particular importance for physicians treating individuals with ID who have psychiatric disorders or behavioral problems to take ASD into account as a differential diagnosis so that appropriate treatment can be initiated.
Irrespective of the IQ the diagnosis is based on an impairment of social interaction and communication and restricted repetitive interests presenting before the age of 3 (infantile or Kanner autism). ASD can be diagnosed as a separate disorder in adults with ID, however, the social and communicative abilities in respect of the cognitive and developmental level have to be considered.
Due to reduced verbal capacity, high prevalence of physical and mental disorders, difficulties in taking the past medical history and presentation of atypical symptoms, the diagnostic assessment for autism in adults with ID is challenging.
This article describes the typical symptoms, diagnostic approach, frequent comorbidities, differential diagnoses treatment options and their limitations for adults with ID suspected of having ASD.

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    • "First, the level of ID differed between groups; the ID/ ASD subgroup exhibited higher levels of ID than did the ID-only subgroup. This finding reflects the increased prevalence of ASD in individuals with lower intellectual functioning (Cooper, Smiley, Morrison, Williamson, & Allan, 2007; de Bildt, Sytema, Kraijer, & Minderaa, 2005; Sappok et al., 2010) and is a common phenomenon in studies assessing ASD in individuals with ID (Sappok, Diefenbacher, Budczies, et al., 2013; Sappok, Heinrich, et al., 2013). Second, all patients had comorbid psychiatric disorders or serious behavioral problems upon admission. "
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    ABSTRACT: Given the strong association between intellectual disability (ID) and autism spectrum disorder (ASD), standardized instruments for the assessment of ASD in adults with ID are desirable. The Diagnostic Behavioral Assessment for ASD – Revised (DiBAS-R) is a DSM-5/ICD-10 based caregiver-report screening tool that consists of 19 Likert-scaled items. This study evaluated the item-validities, item-difficulties, item-variances, part-whole corrected item total-correlations, reliability, and the factorial, diagnostic, and convergent/discriminant validities of the DiBAS-R in a clinical, adult ID sample (N = 219). Factor analysis yielded two consistent dimensions; i.e., social interaction/communication and stereotypy/rigidity/sensory abnormalities. The diagnostic validity was adequate, as reflected by an area under the curve of 0.89 and balanced sensitivity and specificity values of 81%. The DiBAS-R total scores were significantly correlated with the Social Communication Questionnaire (r = 0.52), the Scale for Pervasive Developmental Disorders in Mentally Retarded Persons (r = 0.50), and the Autism-Checklist (r = 0.59), while no significant correlation with the Modified Overt Aggression Scale was observed. The interrater reliability was excellent (ICC = 0.88). These findings indicate that the DiBAS-R is a promising and psychometrically sound instrument for ASD screening of adults with ID.
    No preview · Article · Apr 2014 · Research in Autism Spectrum Disorders
    • "First, the level of ID differed between groups; the ID/ ASD subgroup exhibited higher levels of ID than did the ID-only subgroup. This finding reflects the increased prevalence of ASD in individuals with lower intellectual functioning (Cooper, Smiley, Morrison, Williamson, & Allan, 2007; de Bildt, Sytema, Kraijer, & Minderaa, 2005; Sappok et al., 2010) and is a common phenomenon in studies assessing ASD in individuals with ID (Sappok, Diefenbacher, Budczies, et al., 2013; Sappok, Heinrich, et al., 2013). Second, all patients had comorbid psychiatric disorders or serious behavioral problems upon admission. "
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    ABSTRACT: Background: One in four individuals with intellectual disability (ID) are additionally diagnosed with autism spectrum disorders (ASD) that may not be recognized und thus remain untreated until adulthood. Diagnosing ASD in adults with ID is challenging and there is a lack of specific diagnostic measures. Methods: The Diagnostic Behavioral Assessment for ASD (DiBAS) is a DSM-5/ICD-10 based caregiver-report screener consisting of 20 Likert-scaled items. This study evaluates the item validities and -difficulties, and the scale's feasibility and validity in a clinical, adult ID sample (N = 91) from 8/2009 to 12/2011. Results: The DiBAS was applicable in all individuals (100 %) and yielded an adequate diagnostic validity reflected by ROC analysis and an AUC of 0.808. Using a cut-point of 30, the sensitivity and specificity values were 83 % and 64 %, the agreement with the final diagnostic classification was 74 %, and Cohen's kappa was 0.469. Single item analysis revealed 12 valid DiBAS variables that predominantly could be assigned to the social interaction and non-verbal communication domains; item difficulties varied from 0.21 to 0.84. The scale's internal consistency was appropriate (Cronbach's alpha 0.749). Conclusions: The DiBAS is a promising psychometrical sound scale of high feasibility to screen for ASD in adults with ID, which could be further specified by single item analysis.
    No preview · Article · Mar 2014 · Psychiatrische Praxis
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    • "), besteht ein erheblicher Forschungsbedarf in dieser Subpopulation (Sappok et al. 2010). Umfangreiche molekulargenetische Untersuchungen konnten trotz der Fortschritte in den letzten 20 Jahren keine grundlegenden Anfälligkeitsgene für das Vorliegen einer ASS endgültig identifizieren (Klauck et al. 2011). "

    Full-text · Article · Jun 2012
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