Linking PTSD, Trauma, & ASD

Research Paper Title

Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits.

Background

Individuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors.

This study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group.

Methods

Questionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults.

Results

Rates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group.

Conclusions

High rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.

Reference

Rumball, F., Brook, L., Happe, F. & Karl, A. (2021) Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2020.103848. Online ahead of print.

On This Day … 09 December

People (Births)

  • 1926 – Jan Křesadlo, Czech-English psychologist and author (d. 1995).
  • 1972 – Saima Wazed Hossain, Bangladeshi psychologist.

Jan Kresadlo

Václav Jaroslav Karel Pinkava (09 December 1926 to 13 August 1995), better known by his pen name Jan Křesadlo, was a Czech psychologist who was also a prizewinning novelist and poet.

An anti-communist, Pinkava emigrated to Britain with his wife and four children following the 1968 invasion of Czechoslovakia by the Soviet-led armies of the Warsaw pact. He worked as a clinical psychologist until his early retirement in 1982, when he turned to full-time writing. His first novel “Mrchopěvci” (GraveLarks) was published by Josef Škvorecký’s emigre publishing house 68 Publishers, and earned the 1984 Egon Hostovský prize.

He chose his pseudonym (which means firesteel) partly because it contains the uniquely Czech sound ř; in addition, he was fond of creating more pseudonyms such as Jake Rolands (an anagram), J. K. Klement (after his grandfather, for translations into English), Juraj Hron (for his Slovak-Moravian writings), Ferdinand Lučovický z Lučovic a na Suchým dole (for his music), Kamil Troud (for his illustrations), Ἰωάννης Πυρεῖα (for his Astronautilia), and more.

Pinkava was also active in choral music, composing (among others) a Glagolitic Mass. As well, he worked in mathematical logic, discovering the many-valued logic algebra which bears his name.

A polymath and polyglot, Pinkava was fond of setting intense goals for himself, such as translating Jaroslav Seifert’s interwoven sonnet cycle about Prague, ‘A Wreath of Sonnets’. He published a collection of his own poems in seven languages. Perhaps his most staggering achievement is ΑΣΤΡΟΝΑΥΤΙΛΙΑ Hvězdoplavba, a 6575-line science fiction epic poem, an odyssey in classical Homeric Greek, with its parallel hexameter translation into Czech. This was published shortly after his death, in a limited edition. Only his first, prize-winning novel has been published in English translation, as GraveLarks in a bilingual edition in 1999 and in a revised edition in 2015.

He is the father of film director Jan Pinkava who received an Oscar for Geri’s Game in 1998 and also illustrated GraveLarks.

Saima Wazed

Saima Wazed Hossain (born 09 December 1972) is a Bangladeshi autism activist. She is the daughter of Bangladesh’s Prime Minister, Sheikh Hasina. She is a member of the World Health Organisation’s (WHO) 25-member Expert Advisory Panel on mental health. To her family, she is known simply as “Putul”.

Early Life and Education

She was born to Sheikh Hasina, the present Prime Minister of Bangladesh, and M.A. Wazed Miah, a nuclear scientist. Her brother is Sajeeb Wazed Joy. She graduated from Barry University. She is a licensed school psychologist.

Career

She organized the first South Asian conference on Autism in 2011 in Dhaka, Bangladesh. She is the chairperson of National Advisory Committee on Autism and Neurodevelopmental disorders. She campaigned for “Comprehensive and Coordinated Efforts for the Management of Autism Spectrum Disorders” resolution at the World Health Assembly which adopted the resolution, Autism Speaks praised her for spearheading “a truly global push for support for this resolution”.

In November, 2016, Wazed had been elected as chairperson of International Jury Board meeting of UNESCO for Digital Empowerment of Persons with Disabilities.

In April 2017, Wazed has been designated as WHO Champion for Autism” in South-East Asia. In July, 2017 she became the Goodwill Ambassador of the WHO for autism in South-East Asia Region.

Award

In 2016, Wazed has conferred WHO’s South-East Asia Region Award for Excellence in Public Health. In 2017, she has been awarded the International Champion Award for her outstanding contribution to the field of autism. She received a distinguished alumni award from Barry University for her activism.

Highlighting the Hidden Links between Mental Disorders

Research Paper Title

The hidden links between mental disorders.

Background

Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help.

In 2018, psychiatrist Oleguer Plana-Ripoll was wrestling with a puzzling fact about mental disorders. He knew that many individuals have multiple conditions – anxiety and depression, say, or schizophrenia and bipolar disorder. He wanted to know how common it was to have more than one diagnosis, so he got his hands on a database containing the medical details of around 5.9 million Danish citizens.

You can continue reading the full article here.

Reference

Marshall, M. (2020) The hidden links between mental disorders. Nature. 581(7806), pp.19-21. doi: 10.1038/d41586-020-00922-8.

On This Day … 11 November

People (Births)

  • 1891 – Grunya Sukhareva, Ukrainian-Russian psychiatrist and university lecturer (d. 1981).

People (Deaths)

  • 2002 – Frances Ames, South African neurologist, psychiatrist, and human rights activist (b. 1920).

Grunya Sukhareva

Grunya Efimovna Sukhareva (11 November 1891 to 26 April 1981) was a Soviet child psychiatrist. She was the first to publish a detailed description of autistic symptoms in 1925. The original paper was in Russian and published in German a year later. Sula Wolff translated it in 1996 for the English-speaking world.

She initially used the term “schizoid psychopathy”, “schizoid” meaning “eccentric” at the time, but later replaced it with “autistic (pathological avoidant) psychopathy” to describe the clinical picture of autism. The article was created almost two decades before the case reports of Hans Asperger and Leo Kanner, which were published while Sukhareva’s pioneering work remained unnoticed. This is possibly because of various political and language barriers at the time. Her name was transliterated as “Ssucharewa” when her papers appeared in Germany, and the autism researcher Hans Asperger likely chose not to cite her work, due to his affiliation with the Nazi Party and her Jewish heritage.

Biography

Sukhareva was born in Kiev to the Jewish family of Chaim Faitelevich and Rachil Iosifovna Sukhareva. Between 1917 and 1921, she worked in a psychiatric hospital in Kiev. From 1921, she worked in Moscow, and from 1933 to 1935 she was leading the department of Psychiatry in Kharkov University (Kharkov Psychoneurological Institute).

Sukhareva studied autistic children, and described them in a way which has been compared to the modern description of autism in the DSM V. She helped open schools for autistic children where they participated in multiple activities, such as gymnastics, drawing, and woodwork.

In 1935, Sukhareva founded a Faculty of Pediatric Psychiatry in the Central Institute of Postgraduate Medical Education. In 1938, she led a clinic of childhood psychosis under the Russian SFSR Ministry of Agriculture and Food. For many years, she worked as a councillor and leader of the Psychiatric Hospital of Kashchenko in Moscow.

Sukhareva believed that for personality disorders to appear in children and teenagers, a significant social factor was required. Some of the factors she discussed for personality disorders were a poor family environment and societal structure. She was a pioneer in using the method of suggestion, and fought for children’s rights, stating that difficult children should not be sent to labour camps, but to medical institutions. She also studied PTSD from war injuries sustained by children.

By order of the Moscow Department of Health, the Moscow Scientific and Practical Centre for Mental Health of Children and Adolescents was named after Sukhareva, with the prefix G.E. Sukhareva appended to the front. The centre is the leading specialised medical institution for the treatment of suicidal states in children and adolescents under 18 years of age.

Frances Ames

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody. When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalization for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

Early Life

Ames was born at Voortrekkerhoogte in Pretoria, South Africa, on 20 April 1920, to Frank and Georgina Ames, the second of three daughters. Her mother, who was raised in a Boer concentration camp by Ames’ grandmother, a nurse in the Second Boer War, was also a nurse. Ames never knew her father, who left her mother alone to raise three daughters in poverty. With her mother unable to care for her family, Ames spent part of her childhood in a Catholic orphanage where she was stricken with typhoid fever. Her mother later rejoined the family and moved them to Cape Town, where Ames attended the Rustenburg School for Girls. She enrolled at the University of Cape Town (UCT) medical school where she received her MBChB degree in 1942.

Medical Career

In Cape Town, Ames interned at Groote Schuur Hospital; she also worked in the Transkei region as a general practitioner. She earned her MD degree in 1964 from UCT, the first woman to do so. Ames became head of the neurology department at Groote Schuur Hospital in 1976. She was made an associate professor in 1978. Ames retired in 1985, but continued to work part-time at both Valkenberg and Alexandra Hospital as a lecturer in the UCT Psychiatry and Mental Health departments. In 1997, UCT made Ames an associate professor emeritus of neurology; she received an honorary doctorate in medicine from UCT in 2001. According to Pat Sidley of the British Medical Journal, Ames “was never made a full professor, and believed that this was because she was a woman.”

Cannabis Research

Ames studied the effects of cannabis in 1958, publishing her work in The British Journal of Psychiatry as “A clinical and metabolic study of acute intoxication with Cannabis sativa and its role in the model psychoses”. Her work is cited extensively throughout the cannabis literature. She opposed the War on Drugs and was a proponent of the therapeutic benefits of cannabis, particularly for people with multiple sclerosis (MS). Ames observed first-hand how cannabis (known as dagga in South Africa) relieved spasm in MS patients and helped paraplegics in the spinal injuries ward of her hospital. She continued to study the effects of cannabis in the 1990s, publishing several articles about cannabis-induced euphoria and the effects of cannabis on the brain.

Death

Ames struggled with leukaemia for some time. Before her death, she told an interviewer, “I shall go on until I drop.” She continued to work for UCT as a part-time lecturer at Valkenberg Hospital until six weeks before she died at home in Rondebosch on 11 November 2002. Representing UCT’s psychiatry department, Greg McCarthy gave the eulogy at the funeral. Ames was cremated, and according to her wishes, her ashes were combined with hemp seed and dispersed outside of Valkenberg Hospital where her memorial service was held.

On This Day … 21 October

People (Deaths)

  • 1980 – Hans Asperger, Austrian physician and psychologist (b. 1906).

Hans Asperger

Johann ‘Hans’ Friedrich Karl Asperger (18 February 1906 to 21 October 1980) was an Austrian paediatrician, eugenicist, medical theorist, and medical professor for whom Asperger syndrome is named.

He is best known for his early studies on mental disorders, specifically in children. His work was largely unnoticed during his lifetime except for a few accolades in Vienna, and his studies on psychological disorders acquired world renown only posthumously. He wrote over 300 publications, mostly concerning a condition he termed autistic psychopathy (AP).

There was a resurgence of interest in his work beginning in the 1980s, and due to his earlier work on autism spectrum disorders, Asperger syndrome (AS), was named after him. Both Asperger’s original paediatric diagnosis of AP and the eponymous diagnosis of AS that was named after him several decades later have been controversial.

The controversy has intensified since revelations that, during the Nazi years, Asperger sent at least two disabled children to the Am Spiegelgrund clinic, knowing they would be the subject of cruel experiments and be likely to be euthanised under the Nazi programme named, post-bellum, ‘Aktion T4’.

Book: Family Therapy and The Autism Spectrum

Book Title:

Family Therapy and The Autism Spectrum – Autism Conversations In Narrative Practice.

Author(s): Marilyn J. Montero.

Year: 2016.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

The autism spectrum presents a range of communication, social, and sensory differences that are challenging for clinicians to address. Family Therapy and the Autism Spectrum provides a guide to conceptualising those differences and ways to discuss them with clients and their families. Readers are provided with narrative examples illustrating the application of key concepts introduced in the text. These case examples address issues that range across the life cycle, from families with young children to ones with teens who are emerging as adults. Using the techniques learned in this book, clinicians will be able to guide families towards their positive autism narrative.

This book also features a visual framework to organise the compelling narrative of each person’s autism spectrum pattern of developmental differences or brain style. Using this visual framework and the corresponding descriptive language, clinicians and families can work together to create their “autism conversations.” The conversations lead to the transformative experiences of developing competencies, resiliency, and advocacy for individuals and their families. The conversations also lead individuals with spectrum differences to use empowering language, supporting their ability to develop self-advocacy and self-determination skills.

Can Questionnaires Guide Decisions to Refer Adults in Mental Health Services to Autism Diagnostic Services?

Research Paper Title

Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population.

Background

Autism is difficult to identify in adults due to lack of validated self-report questionnaires.

The researchers compared the effectiveness of the autism-spectrum quotient (AQ) and the Ritvo autism-Asperger’s diagnostic scale-revised (RAADS-R) questionnaires in adult mental health services in two English counties.

Methods

A subsample of adults who completed the AQ and RAADS-R were invited to take part in an autism diagnostic observation schedule (ADOS Module 4) assessment with probability of selection weighted by scores on the questionnaires.

Results

There were 364 men and 374 women who consented to take part.

Recorded diagnoses were most commonly mood disorders (44%) and mental and behavioural disorders due to alcohol/substance misuse (19%), and 4.8% (95% CI [2.9, 7.5]) were identified with autism (ADOS Module 4 10+).

One had a pre-existing diagnosis of autism; five (26%) had borderline personality disorders (all female) and three (17%) had mood disorders.

The AQ and RAADS-R had fair test accuracy (area under receiver operating characteristic [ROC] curve 0.77 and 0.79, respectively).

AQ sensitivity was 0.79 (95% CI [0.54, 0.94]) and specificity was 0.77 (95% CI [0.65, 0.86]); RAADS-R sensitivity was 0.75 (95% CI [0.48, 0.93]) and specificity was 0.71 (95% CI [0.60, 0.81]).

Conclusions

The AQ and RAADS-R can guide decisions to refer adults in mental health services to autism diagnostic services.

Reference

Brugha, T., Tyrer, F., Leaver, A., Lewis, S., Seaton, S., Morgan, Z., Tromans, S. & van Rensburg, K. (2020) Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population. International Journal of Methods in Psychiatric Research. 29(1):e1814. doi: 10.1002/mpr.1814. Epub 2020 Jan 10.