Autism Spectrum Disorders in high secure psychiatric care : a review of literature, future research and clinical directions

Autism spectrum disorder (ASD) refers to a group of neurodevelopmental disorders includingAutism, high functioning autism, Asperger’s syndrome and atypical autism. Althoughdifferent diagnostic classification systems have been adopted over the years, contemporarycriteria follow those set out in the Diagnostic and Statistical Manual of Mental Diseasesversion five - DSM 5 by the American Psychiatric Association (APA, 2013) and theInternational Classification of Diseases eleventh edition by the World Health Organisation –ICD 11 (WHO, 2018) that group all under the single category of Autism Spectrum Disorders.Prevalence studies suggest that ASD is not rare with approximately one in a hundredindividuals in the general population (Baird, Simonoff, Pickles, Chandler, Loucas et al.2006). Although males are more likely to receive the diagnosis of an ASD (Brugha,McManus, Bankart, Scott, Purdon et al., 2011; Loomes, Hull, & Mandy, 2017), it is likelythat the prevalence rate among women is significantly underestimated (Beggiato, Peyre,Maruani, Scheid, Rastam et al. 2016) and with the reasons poorly understood (Adamou,Johnson, & Alty, 2018). Additional studies also suggest that the skewed male / female ratio isunevenly distributed across the spectrum (Kikovski et al. 2013) and may actually decrease asthe symptom severity of ASD increases (Werling & Geschwind, 2013). Having an ASD isalso considered to be life-long. Whilst the causation behind having an ASD remains unknown, likely explanations include genetic / environmental interactions (Chaste &Leboyer, 2012) resulting in atypical brain maturation and a disconnection between key brainregions (Ecker, 2016). It is also common for individuals with an ASD to have otherneurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD)(Matson, Rieske & Williams, 2013; Taylor, Charman, & Ronald, 2015; Antshel, Zhang-James, Wagner, Ledesma, & Faraone, 2016) and intellectual difficulties (Matson &Shoemaker, 2009), neurological issues such as epilepsy (Brookes-Kayal, 2010) and sensorydifficulties related to vision and hearing (Kancherla, Naarden Braun & Yeargin-Allsopp,2013). Co-morbid psychiatric disorder including anxiety, depression, obsessive compulsivedisorder and a psychosis may also be present (Ghaziuddin, Ghaziuddin, & Greden, 2002;Hammond & Hoffman, 2014; Matson & Williams, 2014; Moss, Howlin, Savage, Bolton, &Rutter, 2015; Maddox & White, 2015; Bruggink, Huisman, Vuijk, Kraaij, & Garnefski,2016)