Eddie Chaplin

Recreational Substance Use Patterns and Co-Morbid Psychopathology in Adults with Intellectual Disability.

There is very limited evidence on the patterns of recreational substance use among adults with Intellectual Disabilities (ID) who have co-morbid mental health problems. In this study we collected clinical and socio-demographic information as well as data on substance use patterns for consecutive new referrals (N = 115) to specialist mental health services for adults with ID in South-East London. The data were recorded from active clinical case notes. About 15% of patients had a history of substance use, however only 8% were currently using substances. Alcohol was the most frequently used substance (80%) followed by cannabis (28%) and cocaine (12%). Overall, substance use was significantly more likely among male patients, those with a mild level of ID and those with a forensic history. Substance use was less likely among patients with autism and more likely among those with schizophrenia spectrum disorders. Logistic regression analyses revealed that those with a forensic history were about five times more likely to have current substance use problems. Male gender was the only predictor for legal substance (alcohol) use. Illicit substance use was about three times more likely among patients with schizophrenia spectrum disorders. The present results highlight the role of illicit substance use as a health risk factor for adults with ID as well as the need to increase awareness within specialist mental health services.

Epilepsy and Intellectual Disability: Does Epilepsy Increase the Likelihood of Co-Morbid Psychopathology?.

Although epilepsy is particularly common among people with intellectual disability (ID) it remains unclear whether it is associated with an increased likelihood of co-morbid psychopathology. We therefore investigated rates of mental health problems and other clinical characteristics in patients with ID and epilepsy (N = 156) as compared to patients with ID but no epilepsy (N = 596). All participants were consecutive referrals to specialist mental heath services. Specialist clinicians agreed on the mental health diagnoses by applying ICD-10 clinical criteria using information gained from interviews with key informants and the patients. Bivariate and multivariate analyses showed that patients with epilepsy were more likely to live in residential housing and have severe ID in line with previous evidence. However, the presence of epilepsy was not associated with an increased likelihood of co-morbid psychopathology. On the contrary, rates of mental health problems, including schizophrenia spectrum, personality and anxiety disorders, were significantly lower among patients with epilepsy. The results are discussed in the context of mood-stabilizing and other psychotropic effects of anti-epileptic drugs in adults with ID and epilepsy, as well as possible diagnostic overshadowing.

Autism spectrum conditions and offending: an introduction to the special edition

Purpose – The purpose of this paper is to offer an overview of the issues from studies that have tried to estimate rates of offending.Design/methodology/approach – Brief review.Findings – There is currently no consensus on the prevalence of people with autism spectrum conditions who offend, due to the limited evidence base. It is also difficult to generalise findings across the criminal justice system and secure services.Originality/value – This paper brings together a summary of key studies that have estimated the numbers of offenders with autism spectrum conditions over the last 30 years.

Prisoners with neurodevelopmental disorders

Purpose – The purpose of this paper is to review the evidence on providing services to people with neurodevelopmental disorders in prisons, with a focus on those prisoners with autism spectrum disorder (ASD).Design/methodology/approach – Electronic databases were used to search for literature specifically on ASD in prisons. The literature was supplemented with the authors’ experiences of carrying out research on ASD in prison.Findings – The searches only identified four articles and therefore the broader literature on people with ASD and other developmental disorders was reviewed in relation to the prison context.Originality/value – The paper highlights the current limited evidence base on prisoners with autism spectrum disorders.

Mental ill-health and care pathways in adults with intellectual disability across different residential types

The aim of this study was to investigate co-morbid psychopathology and clinical characteristics of adults with ID living across different types of residential settings. All participants were first time referrals to specialist services in South-East London who lived either with their family (N=375) or in supported residence (N=280) or independently (N=95). Psychiatric diagnoses were based on ICD 10 criteria following clinical interviews with key informants and patients. Logistic regression analyses showed that personality disorders were more likely to be diagnosed in people who lived independently or in supported residence, while anxiety disorders were more likely in those living with their family. Overall, those who lived in independent residence had higher rates of co-morbid psychopathology. These effects were independent of ID level and age differences. Younger adults were more likely to live with their families while those with higher ID level were about 17 times more likely to live independently. The largest proportion of referrals to outpatients lived in independent residence although there were no significant differences in other care pathways. The findings are discussed in terms of implications for service planning and development.

Characteristics of prisoners with neurodevelopmental disorders and difficulties

BACKGROUND Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures. METHOD This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID. RESULTS The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment. CONCLUSIONS The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities.

Review of Research for People with ID and Mental Health Problems: A View from the United Kingdom.

This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and services for people with ID.

Assessment and diagnosis of psychiatric disorder in adults with autism spectrum disorder

Purpose – Adults with autism spectrum disorder (ASD) present with a range of psychiatric disorders. However, making an accurate diagnosis is challenging. It is important to follow a robust and informed process in the assessment of psychopathology that is centred on the individual and their neurodevelopmental difficulties. The purpose of this paper is to provide clinicians with an evidence-based approach to the assessment process for adults with ASD presenting with a possible co-occurrent psychiatric disorder. Design/methodology/approach – A review of the recent literature was undertaken focusing on key papers that describe the assessment of mental health problems in adults with ASD. Findings – The presentation of psychiatric symptoms is influenced by the underlying developmental disorder and it is often quite different from the one of the general population. Thus, it is essential to undertake a comprehensive psychopathological assessment including a diagnostic assessment of ASD. There is a very small evid...

Autism spectrum disorder traits among prisoners

Purpose – The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD. Design/methodology/approach – ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey. Findings – There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England. Originality/value – Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.

A review of risk factors associated with suicide in adults with intellectual disability

Purpose – Suicide is one of the top three leading causes of death amongst those aged between 15 and 44 years; and tenth leading cause of death in the wider population. The base rates of suicide, suicide attempts and suicide-related behaviours are comparably low in the general population with between 17 and 68 per cent of individuals who successfully commit suicide having made a previous attempt to take their own life. As recently as the 1980s it was still a widely held belief that individuals with intellectual disability (ID) did not have the cognitive capacity to experience mental health problems and this acted as a “buffer” against suicidal behaviour. The paper aims to discuss these issues. Design/methodology/approach – The literature review covered the time period 1993-2013 and returned 117 studies, 77 of which related to individuals with ID, 37 of which related to adults. Following screening titles and abstracts 28 articles were removed. A total of nine studies were found to be eligible for inclusion...