Aja Louise Murray

Do urban environments increase the risk of anxiety, depression and psychosis? An epidemiological study.

BACKGROUND The present study aimed to investigate whether there is an association between type of living environment (urban versus rural) and anxiety, depression and psychosis in the Scottish population. METHODS Data were obtained from the Scottish Neighbourhood Statistics database on Scottish Index of Multiple Deprivation and urban-rural classifications for 6505 data zones across Scotland. Multiple regression was used to test the association between prescriptions for psychotropic medication for anxiety, depression and psychosis, and type of living environment according to urban-rural classification, controlling for a range of socio-economic factors. RESULTS Urban-rural classification significantly predicted poorer mental health both before (β=-.29) and after (β=-.20) controlling for a large number of socio-economic variables, with more urban areas having higher rates of prescription for psychotropic medication for anxiety, depression and psychosis. LIMITATIONS The current study focussed on macro-level variables and did not include individual level data. As such, the study did not include data on individual diagnoses, but instead used drug prescriptions for anxiety, depression and psychosis as a proxy for level of affective disorders within data zones. CONCLUSION More urban living environments in Scotland are associated with higher rates of prescription for psychotropic medication for anxiety, depression and psychosis.

Screening for offenders with an intellectual disability: The validity of the Learning Disability Screening Questionnaire

The study assessed the validity of an intellectual disability screening tool, the Learning Disability Screening Questionnaire (LDSQ), in three forensic settings: a community intellectual disability forensic service; a forensic in-patient secure unit and a prison, using data for 94 individuals. A significant positive relationship was found between full scale IQ and LDSQ score, indicating convergent validity. Discriminative validity was indicated by, firstly, a significant difference in the LDSQ scores between those with and without an intellectual disability, with those with a diagnosis of intellectual disability, scoring significantly lower. Secondly, a ROC analysis indicated that the sensitivity and specificity of the LDSQ were both above 80%. The screening tool was found to have lower sensitivity in the forensic populations than was obtained in the original community standardisation sample, but had slightly higher specificity. Limitations and implications of the study are discussed.

Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder

This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.2

Brief Report: An Evaluation of the AQ-10 as a Brief Screening Instrument for ASD in Adults

There is a need for brief screening instruments for autistic spectrum disorders (ASD) that can be used by frontline healthcare professionals to aid in the decision as to whether an individual should be referred for a full diagnostic assessment. In this study we evaluated the ability of a short form of the autism spectrum quotient (AQ) questionnaire, the 10 item AQ-10, to correctly classify individuals as having or not having ASD. In a sample of 149 individuals with ASD and 134 controls without an ASD diagnosis, we found that the full AQ (AQ-50) abridged AQ (AQ-S) and AQ-10 all performed well as a screen for ASD. ROC analysis indicated that sensitivity, specificity and area under the curve were very similar at suggested cut-off’s for ASD across measures, with little difference in performance between the AQ-10 and full AQ-50. Results indicate the potential usefulness of the AQ-10 as a brief screen for ASD.

The Evaluation of a Screening Tool for Children with an Intellectual Disability: The Child and Adolescent Intellectual Disability Screening Questionnaire.

The study outlines the evaluation of an intellectual disability screening tool, the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q), with two age groups. A number of aspects of the reliability and validity of the CAIDS-Q were assessed for these two groups, including inter-rater reliability, convergent and discriminative validity. For both age groups, a significant positive relationship was found between full scale IQ and CAIDS-Q score, indicating convergent validity. Significant differences were found in the CAIDS-Q scores between those with and without an intellectual disability, with the former group scoring significantly lower. The sensitivity and specificity of the CAIDS-Q were above 96.7% and 85.5% respectively for the younger group and 90.9% and 94.9% respectively for the older group. Limitations and implications of the study are discussed.

What range of trait levels can the Autism-Spectrum Quotient (AQ) measure reliably? An item response theory analysis.

It has previously been noted that inventories measuring traits that originated in a psychopathological paradigm can often reliably measure only a very narrow range of trait levels that are near and above clinical cutoffs. Much recent work has, however, suggested that autism spectrum disorder traits are on a continuum of severity that extends well into the nonclinical range. This implies a need for inventories that can capture individual differences in autistic traits from very high levels all the way to the opposite end of the continuum. The Autism-Spectrum Quotient (AQ) was developed based on a closely related rationale, but there has, to date, been no direct test of the range of trait levels that the AQ can reliably measure. To assess this, we fit a bifactor item response theory model to the AQ. Results suggested that AQ measures moderately low to moderately high levels of a general autistic trait with good measurement precision. The reliable range of measurement was significantly improved by scoring the instrument using its 4-point response scale, rather than dichotomizing responses. These results support the use of the AQ in nonclinical samples, but suggest that items measuring very low and very high levels of autistic traits would be beneficial additions to the inventory. (PsycINFO Database Record

Structural validation of the abridged Autism Spectrum Quotient–Short Form in a clinical sample of people with autism spectrum disorders

The primary aim of this article was to provide a structural validation of the 28-item Autism Spectrum Quotient–Short Form questionnaire in a sample of adults with clinically diagnosed autism spectrum disorders (n = 148). Confirmatory factor analysis demonstrated that the proposed structure, comprising a second-order Social Skills factor subsuming first-order factors of Social Skills, Routine, Switching and Imagination, and a Numbers/Patterns factor showed good acceptable fit to the data (χ2 = 464.27(345), p < .05; comparative fit index = .91; Tucker Lewis index = .90; root mean squared error of approximation = .048; weighted root mean square residual = 0.98). Summed mean scores for the total sample, and males and females separately, showed no significant differences to previously reported means, with the exception of Numbers/Patterns, for which the current sample reported significantly lower means in both males (t = 3.37, p < 0.001) and females (t = 2.33, p < 0.05). The results provide support for both the proposed structure of the AQ-S and the stability of total and subscale mean scores in different samples of participants with autism spectrum disorder diagnoses.

Measurement invariance in the assessment of people with an intellectual disability

Intellectual assessment is central to the process of diagnosing an intellectual disability and the assessment process needs to be valid and reliable. One fundamental aspect of validity is that of measurement invariance, i.e. that the assessment measures the same thing in different populations. There are reasons to believe that measurement invariance of the Wechsler scales may not hold for people with an intellectual disability. Many of the issues which may influence factorial invariance are common to all versions of the scales. The present study, therefore, explored the factorial validity of the WAIS-III as used with people with an intellectual disability. Confirmatory factor analysis was used to assess goodness of fit of the proposed four factor model using 13 and 11 subtests. None of the indices used suggested a good fit for the model, indicating a lack of factorial validity and suggesting a lack of measurement invariance of the assessment with people with an intellectual disability. Several explanations for this and implications for other intellectual assessments were discussed.

Mokken Scales for Testing Both Pre- and Postintervention: An Analysis of the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE–OM) Before and After Counseling.

Mokken scaling is increasingly being applied to assessing the extent to which clinical scales possess clinically useful properties, especially invariant item ordering (IIO). These scales are often used to track progress in symptoms over time to evaluate the success of an intervention. Such interventions are designed to affect psychopathological trait levels overall but may in some cases act disproportionately on some symptoms over others. As a result, there is no guarantee that the item orderings of a clinical scale will be preserved between the point at which individuals begin treatment and the point at which they can be considered recovered. In these situations, many of the potential benefits of IIO are undermined because an IIO identified at either time point will not be informative about changes in symptoms over time. In this study, we aimed to assess the extent to which the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) retained the same item orderings in a sample of individuals when initially presenting for counseling treatment and when discharged. From the 34 items of the CORE-OM we found a subset of 10 items exhibiting monotonicity, invariant item ordering, and highly similar item orderings when measured at both time points.

Assessing the accuracy of the WISC-IV seven subtest short form and the Child and Adolescent Intellectual Disability Screening Questionnaire in identifying intellectual disability in children

Little research has been conducted into the accuracy of abbreviated assessments in identifying children and young people with an intellectual disability (ID). The present study compared two such methods in a clinical population of individuals with (n = 106) and without (n = 170) ID: a 7-subtest short form of the Wechsler Adult Intelligence Scales for Children—fourth edition (WISC-IV) proposed by Crawford and colleagues and the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q). Both the CAIDS-Q and the WISC-IV short form had high and comparable levels of predicting group classification (88% and 91% correct classification, respectively). Both methods would appear to offer clinicians and researchers an efficient and accurate means of identifying those who are likely to have ID. The WISC-IV short form was slightly more accurate, but the CAIDS-Q may offer the advantages of being shorter to administer and having no requirement for the user to have a particular qualification or training.