Search

We examined temperament and character profiles of 128 adults with autism spectrum disorder (ASD) or attention deficit and hyperactivity disorder (ADHD). Participants completed the abbreviated Temperament and Character Inventory. The ASD and ADHD groups showed distinct temperament profiles (ADHD: high novelty seeking, ASD: low reward dependence, high harm avoidance) and low character scores in both groups. We then stratified ASD and ADHD into current substance use disorder (SUD+), former (SUD;), or no history of Substance Use Disorder (SUD-). Novelty seeking and reward dependence were only significantly lower for ASD/SUD-, but normal for ASD/SUD; and ASD/SUD+ subgroups. Persistence scores were highest in both SUD; subgroups. We concluded that temperament profiles of ASD and ADHD patients differ significantly, and are similar to profiles reported in earlier studies, but appear to depend on the SUD status. Surprisingly, normal social orientation is found in ASD patients with former or current SUD. High persistence scores characterize patients who overcome SUD. [ABSTRACT FROM AUTHOR]

Background: Eye contact is one of the most fundamental forms of interhuman communication. However, to date, there has been no comprehensive research comparing how eye contact is made and interpreted in all possible populations worldwide. This study presents a summary of the existing literature on these modalities stratified to social categorizations and psychiatric disorders., Method: A scoping review with critical appraisal of the literature according to the Joanna Briggs Institute (JBI) methodology. Databases AnthroSource, Medline, CINAHL, the Psychology and Behavioral Sciences Collection (EBSCO) and PsychInfo were searched., Results: 7068 articles were screened for both the grey literature and reference lists, of which 385 were included, 282 for social categorizations and 103 for psychiatric disorders. In total, 603 thematic clustered outcomes of variations were included. Methodological quality was generally moderate to good., Conclusions: There is a great degree of variation in the presentation and interpretation of eye contact between and within populations. It remains unclear why specific variations occur in populations. Additionally, no gold standard for how eye contact should be used or interpreted emerged from the studies. Further research into the reason for differences in eye contact between and within populations is recommended.

Backgrounds: Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts., Methods: At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group ( n = 63) or TAU control group ( n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes., Results: At end-of-treatment, DBT significantly reduced both suicidal ideation ( z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts ( z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT ( z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months ( z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition., Conclusions: DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.

The association between substance use and autism spectrum disorder (ASD) is complex. Although sensory processing difficulties are highly prevalent in individuals with ASD, data on the association between sensory processing and substance use in ASD are limited. This study aimed to investigate the association between sensory processing patterns and alcohol use in adults with ASD. Kruskal-Wallis tests were performed on questionnaire data (Adolescent/Adult Sensory Profile and Alcohol Use Disorders Identification Test - Consumption) of 101 adults with ASD. Sensory processing difficulties are associated with alcohol use in adults with ASD. Differences in sensory processing between alcohol-based subgroups vary per specific sensory processing pattern: drinkers reported 6.5 to 8 points higher levels of low registration [χ 2 (2) = 12.408, p = .002, 99 % CI (.002.002)], non-hazardous drinkers reported 9 points higher levels of sensory sensitivity [χ 2 (2) = 6.868, p = .031, 99 % CI (.031, .032)], and hazardous drinkers reported 7.5 points higher levels of sensory seeking [χ 2 (2) = 6.698, p = .034, 99 % CI (.034, .035)], all in comparison with non-drinkers on scales ranging from 15 to 75. Our proof-of-concept study indicates that vulnerability in some individuals with ASD for substance use disorders might be explained by sensory processing difficulties. Whether alcohol is used as 'self-medication' or is associated with other neurobiological vulnerabilities needs further investigation in larger follow-up studies., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Understanding lone actor grievance-fueled violence remains a challenge. We believe that the concept of grievance provides an opportunity to add an engaged, first-person perspective to the assessment of lone actor extreme violence. We propose an enactivist philosophical approach that can help to understand the why and how of the pathway from grievance to violent extremism. Enactivism sees grievance as a dynamic, interpersonal, and context-sensitive construct that indicates how (potential) offenders make sense of the world they live in and how under certain circumstances it fuels violent behavior. Hence, grievance should not be understood as a given thing, but as an unfolding experience that involves sense-making through (regulation of one's) interaction with the (social) environment. This (self-)relational and ecological understanding requires another approach than looking at demographic factors or life histories, only from an outsider's perspective. Enactivism invites us to look at such risk factors as external indices of an ongoing process of active self-regulation and sense-making, and in some cases spiraling toward extreme violence. To understand the mindset of the offender we need to look more in depth at the processes that shape this mindset: why does this person, with this history, in this context, and at this point in time, proceed to use violence? The enactivist approach to the mind offers a complementary framework that may help us to understand the dynamics of grievance as a possible precursor to violent extremism. It also helps to appreciate why the relative unpredictability of the pathway toward lone actor extreme violence is not necessarily a sign of empirical weakness but a matter of principle due to the non-linearity of the processes involved. We end by summarizing how enactivism could contribute to the prevention of extremist violence and research and how it can help to avoid reinforcing stigmas and re-establishing a confirmation bias., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sizoo, Strijbos and Glas.)

In clinical practice, many individuals with psychiatric disorders report difficulties in sensory processing, including increased awareness or sensitivity to external stimuli. In this meta-analysis, we examined the sensory processing patterns of adolescent and adult individuals with a broad spectrum of different psychiatric conditions. A systematic search in various databases resulted in the inclusion of 33 studies (N=2008), all using the Adolescent/Adult Sensory Profile (AASP). By comparing diagnostic subgroups to the corresponding reference group of the AASP, we detected a general pattern of sensory processing, indicating elevated levels of low registration, sensory sensitivity and sensory avoiding and lowered sensory seeking behavior in patients with different types of psychiatric disorders. The majority of effect sizes were large to very large. In conclusion, sensory processing difficulties can be considered as a non-specific transdiagnostic phenotype associated with a broad spectrum of psychiatric conditions. Further research into the relevance and role of sensory processing difficulties in psychiatric disorders may improve long-term prognosis and treatment., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Although previous research suggests an association between sensory processing and perceived stress in a broad spectrum of mental health conditions, it remains unclear whether this phenomenon occurs independently from psychopathology. The present study investigated the association between sensory processing patterns, perceived stress and occupational burnout as a stress-related condition in a working population. We focused on different aspects of sensory processing and used the momentum of a particularly stressful period: during the first months of the global COVID-19 crisis. A total of 116 workers at a mental healthcare institution in The Netherlands completed the Adolescent/Adult Sensory Profile (AASP), the Perceived Stress Scale (PSS-10) and the Burnout Assessment Tool (BAT). Our results demonstrated that higher scores on sensory sensitivity and low registration were associated with higher scores on perceived stress and core burnout symptoms. Sensory hypersensitivity was also associated with more secondary burnout symptoms. Associations were not driven by underlying sensory-related disorders (e.g., ASD or ADHD). In conclusion, sensory processing difficulties are relevant predictors of stress and occupational burnout, also in healthy employees. This phenomenon warrants further attention, as relatively simple adjustments in working environment may possess important preventive effects.

Background: The literature suggests that intersectoral collaboration is important to prevent attacks by radicalised persons with mental health issues, but it is not clear what this collaboration entails., Aim: To provide insight in how perceptions of radicalisation and mental health issues differ between mental health care and the security domain, and how this affects intersectoral collaboration., Method: Qualitative data were obtained through focus group discussions and interviews with professionals and training staff from mental health care and the security domain., Results: The focus in mental health was on treatment of patients, while safety dominated in the security domain. Collaboration was hampered by too little understanding of, and for, each other's domain. The separation of radicalisation with mental health issues into prosecution or mental health care impaired an integrated approach. Privacy rules were experienced as a significant barrier for collaboration., Conclusion: Intersectoral collaboration works effectively if participants maintain their professional standards and only share information that is necessary and justified to make an effective plan. Many identified obstacles are more general in nature, and not confined to specific cases of radicalisation with mental health issues. Dutch Care and Safety Houses offer a sound base for intersectoral collaboration. Future professionals from different domains ought to be familiarized with each other's (im)possibilities, tasks, and roles.

Autism spectrum disorder (ASD) may be accompanied by aggressive behavior and is associated with sensory processing difficulties. The present study aims to investigate the direct association between sensory processing and aggressive behavior in adults with ASD. A total of 101 Dutch adult participants with ASD, treated in outpatient or inpatient facilities, completed the Adult/Adolescent Sensory Profile (AASP), the Reactive-Proactive Aggression Questionnaire (RPQ), and the Aggression Questionnaire-Short Form (AQ-SF). Results revealed that sensory processing difficulties are associated with more aggressive behavior (f2=0.25), more proactive (f2=0.19) and reactive aggression (f2=0.27), more physical (f2=0.08) and verbal aggression (f2=0.13), and more anger (f2=0.20) and hostility (f2=0.12). Evidence was found for an interaction of the neurological threshold and behavioral response on total aggression and hostility. Participants with higher scores in comparison to the norm group in sensory sensitivity had the highest risk of aggressive behavior. In conclusion, clinical practice may benefit from applying detailed diagnostics on sensory processing difficulties when treating aggressive behavior in adults with ASD.

Background: Conspiracy theories are popular during the COVID-19 pandemic. Conspiratorial thinking is characterised by the strong conviction that a certain situation that one sees as unjust is the result of a deliberate conspiracy of a group of people with bad intentions. Conspiratorial thinking appears to have many similarities with paranoid delusions., Aim: To explore the nature, consequences, and social-psychological dimensions of conspiratorial thinking, and describe similarities and differences with paranoid delusions., Method: Critically assessing relevant literature about conspiratorial thinking and paranoid delusions., Results: Conspiratorial thinking meets epistemic, existential, and social needs. It provides clarity in uncertain times and connection with an in-group of like-minded people. Both conspiratorial thinking and paranoid delusions involve an unjust, persistent, and sometimes bizarre conviction. Unlike conspiracy theorists, people with a paranoid delusion are almost always the only target of the presumed conspiracy, and they usually stand alone in their conviction. Furthermore, conspiracy theories are not based as much on unusual experiences of their inner self, reality, or interpersonal contacts. CONCLUSIONS Conspirational thinking is common in uncertain circumstances. It gives grip, certainty, moral superiority and social support. Extreme conspirational thinking seems to fit current psychiatric definitions of paranoid delusions, but there are also important differences. To make a distinction with regard to conspiratorial thinking, deepening of conventional definitions of delusions is required. Instead of the strong focus on the erroneous content of delusions, more attention should be given to the underlying idiosyncratic, changed way of experiencing reality.

Background: Many persons with autism spectrum disorder (ASD) are treated in long-term specialised care. In this population, suicidal behaviour troubles patients, families, and specialists in the field because it is difficult to treat. At present, there is no documented effective therapy for suicidal behaviour in ASD (Autism Research 7:507-521, 2014; Crisis 35:301-309, 2014). Dialectical Behaviour Therapy (DBT) is an efficacious treatment programme for chronically suicidal and/or self-harm behaviour in patients with Borderline Personality Disorder (J Psychiatry 166:1365-1374, 2014; Linehan MM. Cognitive behavioural therapy of borderline personality disorder. 1993). This study will evaluate the efficacy of DBT in persons with ASD and suicidal/ self- destructive behaviour in a multicentre randomised controlled clinical trial., Method: One hundred twenty-eight persons with autism and suicidal and/or self-harming behaviour will be recruited from specialised mental healthcare services and randomised into two conditions: 1) the DBT condition in which the participants have weekly individual cognitive behavioural therapy sessions and a 2.5 h skills training group session twice per week during 6 months, and 2) the treatment as usual condition which consists of weekly individual therapy sessions of 30-45 min with a psychotherapist or social worker. Assessments will take place at baseline, at post-treatment (6 months), and after a follow-up period of 12 months. The mediators will also be assessed at 3 months. The primary outcome is the level of suicidal ideation and behaviour. The secondary outcomes are anxiety and social performance, depression, core symptoms of ASD, quality of life, and cost-utility. Emotion regulation and therapeutic alliance are hypothesised to mediate the effects on the primary outcome., Discussion: The results from this study will provide an evaluation of the efficacy of DBT treatment in persons with ASD on suicidal and self-harming behaviour. The study is conducted in routine mental health services which enhances the generalisability of the study results to clinical practice., Trial Registration: ISRCTN96632579. Registered 1 May 2019. Retrospectively registered.

The study investigated whether EMDR is a feasible therapy for adults with ASD and a history of adverse events, and whether it is associated with reductions in symptoms of PTSD, psychological distress and autism. Participants received 6 to 8 weeks treatment as usual (TAU), followed by a maximum of 8 sessions EMDR added to TAU, and a follow-up of 6-8 weeks with TAU only. Results showed a significant reduction of symptoms of post-traumatic stress (IES-R: d = 1.16), psychological distress (BSI: d = 0.93) and autistic features (SRS-A: d = 0.39). Positive results were maintained at follow-up. The results suggest EMDR therapy to be a feasible and potentially effective treatment for individuals with ASD who suffer from the consequences of exposure to distressing events.

Background: There is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD., Methods: A multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined., Results: In MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = -3.44 (-5.75, -1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩾30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up., Conclusions: MBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.

Huntington's disease (hd) is characterised by a triad of neuropsychiatric symptoms, motor disturbances and cognitive decline. If initial symptoms are of neuropsychiatric nature they maybe misinterpreted, which can lead to delayed diagnosis. Three examples of delayed hd diagnosis in a psychiatric setting are discussed.

Background: Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning, these studies have methodological limitations. This study will take account of these limitations and will examine the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in further detail., Methods/design: A multi-centre, parallel-group, randomised controlled trial will be conducted in N = 120 adults with ADHD. Patients will be randomised to MBCT in addition to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline and at three, six and nine months after baseline. Primary outcome measure will be severity of ADHD symptoms rated by a blinded clinician. Secondary outcome measures will be self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. In addition, a cost-effectiveness analysis will be conducted., Discussion: This trial will offer valuable information about the clinical and cost-effectiveness of MBCT in addition to TAU compared to TAU alone in adults swith ADHD., Trial Registration: ClinicalTrials.gov NCT02463396. Registered 8 June 2015.

Background: The law on medical research with humans enables researchers to request exemption from the 'mandatory' insurance for such test-subjects. Because this type of insurance is expensive, some research projects are abandoned at an early stage., Aim: To argue that exemption from 'mandatory' test-subject insurance is very rarely requested and granted., Method: We discuss the problems involved, using an example from clinical practice and the literature., Results: The second evaluation report concerning the law on medical research mentions that very few requests are made with regards to exemptions from this type of test-subject insurance. In fact, not only researchers but also medical-ethical committees seem to be unclear about the rules and procedures for requesting and granting exemptions. As a result, there is always a real danger that medical-ethical committees make arbitrary decisions and withhold exemptions., Conclusion: More use needs to be made of the opportunities that the law provides for requesting exemptions from test-subject insurance.

Background: Estimates of the prevalence of autism spectrum disorders (ASD) range from 0.6 to 1.0 per cent of the general population. Among the characteristic traits of ASD are qualitative impairments in social reciprocity and in abstract imagination. Not surprisingly, these traits can affect the personal religion of ASD patients, in the same manner as religious background does., Aim: To determine to what extent the religiousness of religious patients is associated with autistic traits and religious background., Method: Dutch adults attending a Protestant mental healthcare institution as outpatients were asked to complete the 'Questionnaire God Image' (QGI) and the 'Autism Quotient' (AQNL). In this cross-sectional study various aspects of the God image were related to autistic traits and religious background., Results: The more that respondents reported autistic traits, the greater was their fear of God and the less positive were their feelings. Respondents who were strict Calvinists experienced greater fear of God than did other respondents., Conclusion: Treatment of religious patients with asd needs to take into account these patients' greater fear of God and their less positive feelings. Those patients who had had a strict Calvinist upbringing had a more pronounced fear of God.

Objective: Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are developmental disorders that overlap in a number of domains, sometimes complicating clinical distinction between both disorders. Although there is some evidence for a genetic overlap, there are no reports on genes that could differentiate between ASD and ADHD. Furthermore, it is not known whether this genetic overlap is influenced by co-morbid substance use disorders (SUD)., Methods: A total of 110 adult patients with ASD (n=61) or ADHD (n=49) with or without a lifetime history of SUD participated in a study in which we genotyped polymorphisms in five known candidate genes for (one of) the disorders, i.e. the 5HTTLPR in SLC6A4/5-HTT, rs1800497 (TaqIA C>T) in DRD2, rs7794745 in CNTNAP2, rs1843809 in TPH2, and rs6565113 in CDH13. Genotyping was by Taqman-based analysis or by simple sequence length analysis, where appropriate., Results: ASD could be differentiated from ADHD with nominal statistical significance by the 5HTTLPR, and the polymorphisms in TPH2 and CNTNAP2. The results were independent of lifetime SUD status., Conclusions: Serotonergic genes could prove to play an important role in differentiating between ASD and ADHD, but the results of this exploratory study need replication.

Background: Little is known about Autism Spectrum Disorder (ASD) in adults, especially not about ASD with co-morbid Substance Use Disorder (SUD). We wanted to examine how adults with ASD compare to adults with ADHD on prevalence and risk factors for co-morbid SUD, and on disability levels associated with SUD., Methods: We stratified 123 treatment seeking adults with ASD (n=70) or ADHD (n=53), into current, former and no history of SUD (SUD+, SUD(wedge), and SUD-), and conducted interviews to explore associated risk factors and current levels of disability., Results: Prevalence of co-morbid SUD was higher in ADHD than in ASD in our sample (58% versus 30%, p=0.001). There was no statistically significant difference between ASD and ADHD in risk factors or disability scores. Patients with lifetime SUD started regular smoking earlier in life (OR=5.69, C(95%) 2.3-13.8), reported more adverse family events (OR=2.68; CI(95%) 1.2-6.1), and had more parental SUD (OR=5.36; CI(95%) 1.0-14.5). Disability scores were significantly lower in SUD- and SUD(wedge) groups compared to the SUD+ group., Discussion: These findings suggest that ASD and ADHD share similar risk factors for SUD. High disability in ASD and ADHD with SUD may normalize after prolonged abstinence. Early onset of SUD was not associated with more severe disability scores than later onset. Results suggest that a subgroup of patients with former SUD may have a higher level of functioning before the onset of SUD in comparison to those without lifetime SUD., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)