Autism spectrum disorder (ASD) , as defined by Weir, Allison, and Baron (2020), is a medical complication that comes with problems related to behavior and communication. Although ASD can be considered a minor disability, it demands full-time care in a unique facility for handling affected persons. The problem is associated with a variety of signs, symptoms, and skills. Some of the persons living with autism experience difficulty in communication and have an inability to understanding and interpreting what other people feel and think ( Heinrich, Böhm, & Sappok, 2018). As a result, the difficulty makes it hard for persons to express themselves through verbal communication, gestures, touch, or facial expressions. Furthermore, most individuals living with autism exhibit the problem of learning. They may develop their skill unevenly. For instance, they may be unusually good at music or physics but have trouble communicating. As a result of this, Brugha et al. (2016) argue that people living with autism can perform well on problem-solving and analysis tests. Due to alteration in diagnostic criteria, and the application of time, fewer adults have been diagnosed. However, like any other disability, autism does not prohibit one from being healthy. However, it's worth noting that differences in cognitive and communication resulting from autism can complicate the identification and the management of the disability. Also, autism relates to the prevalence of several medical conditions. However, insufficient information is available concerning the prevalence among adults based on a psychiatric.
Other signs symptoms vary widely depending on the individuals and with different severity. Relatively late speaking, lack of interactive play with others among children and social withdrawal have been experienced among individuals with autism, (Mandy et al., 2018). The children cannot express themselves well, even just by screaming to express their feeling for hunger. This study focuses on the prevalence of autism disorder among adults, the general challenges they face in life and programs initiated for them.
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The Literature on Autism Spectrum Disorder
There is no clear cause of autism spectrum disorder in adults. However, the majority of scholars associate it with genetic mutation and the presence of immediate family members with the disease (Mandy et al., 2018). Other factors linked to causes of autism include child delivered by aged parents, relatively low birth weight, and metabolic imbalances. Furthermore, being exposed to heavy metals and toxins from the environment, along with the history of viral infections, have been noted as possible causes of autism (Heinrich et al., 2018).
Adults living with autism tend to face challenges in seeking diagnostic because of numerous reasons. To begin with, individuals not diagnosed with autistic symptoms at their younger age may have mild signs and symptoms, making it harder for a medical practitioner to identify and diagnose autism. Secondly, those who have lived with ASD for long might have found ways of coping up with it. Besides, there is no precise technique of identifying ASD among adults, though there is a high possibility of this situation changing in the future (Mandy et al., 2018). However, the people who doubt that their loved ones may be suffering from ASD can seek a doctor’s intervention. The intervention involves a check through the following inquiry; speaking to the loved ones, checking their physical and mental health, and observing their interaction with other persons. The same action should be taken by individuals who suspect themselves of having autistic symptoms that close family members and friends are unable to detect. Speaking out and seeking medical interventions may result in a diagnosis and better management of ASD.
However, seeking diagnosis can be stimulated by numerous post-diagnosis advantages enjoyed by patients. First, the diagnosis helps one to have relief and a vivid explanation of the challenges they experience throughout their lifetime ( Baghdadli , Russet, & Mottron, 2017). Furthermore, family members gain knowledge and a better understanding of their other family members, colleagues, and friends. Diagnosis is also a road to accessing useful services and benefits that can be found in both workplaces and learning centers. Lastly, it helps to correct the wrong diagnosis, including attention deficit hyperactivity disorder (ADHD). It is worth noting that respecting everyone's needs and wishes are vital. Therefore, every adult is free to diagnose or object to suggestions to diagnose (Ashwood et al., 2016).
Methods of Study
This study employed several investigative procedures to determine the extent of autism in adults. The first one was to investigate the prevalence of ASD, the inpatient study population for psychiatric inpatients, electronic databases such as Pub Med, PsycINFO, Medline, and EMBASE. Furthermore, the method of ancestry for the reference of eligible papers was used. Searches from gray literature were also conducted.
Autism Spectrum Disorder constitutes a range of sub neurodevelopment disorders featured by challenges in communication and social interaction. It also involves behavior that has restricted stereotypes and repetition. Even though autism originates from childhood, its effects significantly persist into the later life of an individual (Weir et al., 2020). Therefore, the persons require a high level of support all their lifetime. Initially, more research focused on ASD in children, but in recent years, an increased focus on ASD for adults and their clinical needs have been realized. However, Mandy et al. (2018) argue that adults with ASD still receive infancy service provision. An advantage of infancy service provision on adults is its ease and availability to ASD patients and those suspected to be suffering from the condition. The critical area in diagnostic is familiarizing with the needs and planning for the care of the patients with autism ( Heinrich et al., 2018).
Different studies show variations in the community-based prevalence rates for people with autism in the total population. The recent research of systematic review estimates the prevalence rates between (0.7-1) percent (Brugha et al., 2016). It is also discovered that intellectual disability (ID) is directly related to autism. According to Ashwood et al. (2016) argument, people with moderate and profound intellectual disabilities have a significantly higher prevalence of autism. The statistic displays found a prevalence of 39.3% (95% confidence interval 31.0-48.4) in the members of autism of this type group, compared to 1.0% (95% confidence interval 0.4-2.2) for the autism participants with mild Intellectual Disability ID, (Brugha et al., 2016). Due to these findings, it's worth noting that ASD represents a significant public health problem both locally and globally. ASD claims over 111 Disability Adjusted Life Years in every 100, 000 persons ( Weir et al., 2020).
However, regard ing Baghdadli et al. (2017), there is still less establishment of an inpatient psychiatric setting despite the high focus on the prevalence of ASD in communities. Several reasons have been cited by researchers in support of the suggestion that there are chances of under diagnosing and overrepresentation of ASD among adults. The reasons for the wrong diagnosis of ASD are numerous, for instance, lack of training among the psychiatrists in conditions originating from childhood. Furthermore, there is a comorbid psychiatric disorder that is common in some people with ASD. The comorbid has the potential to interfere and complicate the picture of diagnostic such as depression, anxiety disorders, bipolar disorders, schizophrenia alcohol, substance abuse, attention deficit hyperactivity disorder, and conditions relating to intellectual disability affect the diagnosis of ASD (Heinrich et al., 2018). In recent decades, the diagnosis of ASD has significantly broadened as compared to the narrowing of those symptoms related to schizophrenia.
Having a broad knowledge of the prevalence of ASD within an inpatient psychiatric setting is of significance to any nation since it is used in the allocation of healthcare providers, and the patients of ASD can provide potential information for a study case. For a better knowledge of the clinical needs of ASD and the treatment approaches, one should consider the identification of persons with Autism Spectrum Disorder. This can otherwise lead to a solution leading to improved therapeutic outcomes and reducing both the long and short length of hospital stay (Mandy et al., 2018).
Study Selection
Studies were included in meeting specific criteria and conditions. The first condition was investigating the prevalence of autism spectrum disorders within the population of psychiatric inpatient. Secondly, individuals involved were adult patients of ages above 16 years. Furthermore, all the participants were subjected to several autism-specific testing before qualifying for investigating the prevalence of autism spectrum disorder. A lot of studies were discovered which specifically patients found to have autism spectrum disorder through routine clinical practice. It is worth noting that some proportions were not considered relevant in this research as they could underestimate prevalence.
For every article viewed in this research, information was extracted regarding the time and the place the study was contacted. The data collected comprised of the number of persons enrolled, screened, and going through an assessment of diagnostic. To avoid the risk of generalization, information from each study was analyzed conclusively.
Assessment Quality
All the used articles qualified basing on the used criteria were kept by only one investigator following the 22 item strobe checklist. No single study was removed as long as it qualified for inclusion.
Results
Basing on the research, four studied were confirmed to have satisfied the necessary criteria of inclusivity. The confirmed studies involved a variety of inpatient psychiatric settings, units of intellectual disabilities, as well as psychiatric hospitals. Noteworthy differences were observed in areas of screening tests, methodology, instruments used, and criteria of diagnosing. The prevalence variant significantly from 2.4 to 9.9%, (Tromans et al. 2019)
Discussion
There is relatively a shortage of qualified research behind the declaration of the need for higher research for the prevalence of ASD in patients. From the experimental studies analyzed, there is a wide-ranging of prevalence estimates. Evidence suggested that there is more ASD prevalence in inpatients psychiatric settings compared to the statistics in community populations. The variance is due to genetic makeup. It is of great importance that the study should contain a combination of intellectual disabilities (ID) and those of non-intellectual disabilities (non ID) and make separate prevalence estimates (Weir et al., 2020). Due to this, there is a limited genuine prevalence study population for a mixed non ID and ID. Further subdivisions in IDs should be considered regarding the severity of ID.
Furthermore, most studies focused on the male population only. Statistics show a higher prevalence among males subjected to diagnostic assessment. Additional work is required to focus on the differences in ASD prevalence in psychiatric inpatient settings. There exists a long time possessed a belief that males have more ASD prevalence than women, majorly the non-ID’s ( Wigham et al., 2019). Another challenge is to determine whether females can camouflage the symptoms of ASD more than males.
Regarding most of the findings from the studies and the inclusion of those from forensic settings, it is clear that the prevalence of ASD increased within inpatient psychiatric settings. However, the data can be easily confused by other elements like lack of information from people with intellectual disabilities in either of the studies ( Wilson et al., 2016). There is also insufficient evidence to support the belief that individuals who have ASD are likely to commit suicide despite clinics considering the condition as of offensively abnormal communication and social interactions. However, the notion may lead to the victims remaining undiagnosed for fear of being convicted of their offenses (Lee, 2018).
The majority of the studies incorporated the use of a multi-stage study design, which identified the progress of diagnostic assessment using screening as a tool. This approach is community-based and is similar since it has been employed by the majority of child and adult population studies (Heinrich et al., 2018). The approach of a multi-stage is reliable and valid in both diagnostic tests and screening.
Funding For Adults with Autism
Several programs have been initiated to offer funding to adults with autism. ACT Today provides grants to families and persons affected with ASD after a thorough assessment and pre-approved treatment. Furthermore, the CARE family grant program provides funds to adults with ASD for medication and therapy sessions.
Education and Employment Position of People with ASD
According to Lee (2018), adults with ASD encounter problems in seeking space in the labor market. Due to their challenges in communication and social interaction, they struggle to get and maintain a professional position. Studies reveal high rates of unemployment as well as insufficient employment among ASD.
Conclusion
To sum up, basing on the limited research presently available, it shows that the prevalence of ASD increased in inpatients about the general population. Therefore, epidemiological research concerning ASD prevalence among adults in psychiatric inpatients needs to be conducted. This is due to the lack of enough and convincing evidence on the current research. When conducting such research, a consideration of assessment tools, designing supporting coverage of a wider victim group, and criteria for diagnostic is essential. Furthermore, proper details of the features of the population to be studied are vital with the prevalence of ID and non ID across all the genders. The specialists for autism are required to provide a target for recognizing people with ASD.
Acknowledgment is to the few programs like but not limited to ACT Today and Care Family, which funds adults with ASD. However, more institutions should direct part of their efforts in helping this adult to attain their diagnosis and maintenance. Furthermore, strategies should be implemented to aid the employment absorption of the adult with ASD.
References
Weir, E., Allison, C., & Baron ‐ Cohen, S. (2020). Identifying and managing autism in adults. Prescriber , 31 (2), 12-16.
Mandy, W., Clarke, K., McKenner, M., Strydom, A., Crabtree, J., Lai, M. C., & Skuse, D. (2018). Assessing autism in adults: An evaluation of the developmental, dimensional and diagnostic interview—Adult Version (3Di-Adult). Journal of autism and developmental disorders , 48 (2), 549-560.
Brugha, T. S., Spiers, N., Bankart, J., Cooper, S. A., McManus, S., Scott, F. J., & Tyrer, F. (2016). Epidemiology of autism in adults across age groups and ability levels. The British Journal of Psychiatry , 209 (6), 498-503.
K. L., Gillan, N., Horder, J., Hayward, H., Woodhouse, E., McEwen, F. S., & Cadman, T. (2016). Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychological medicine , 46 (12), 2595-2604.
Heinrich, M., Böhm, J., & Sappok, T. (2018). Diagnosing autism in adults with intellectual disability: Validation of the DiBAS-R in an independent sample. Journal of autism and developmental disorders , 48 (2), 341-350.
Maddox, B. B., Brodkin, E. S., Calkins, M. E., Shea, K., Mullan, K., Hostager, J., & Miller, J. S. (2017). The accuracy of the ADOS-2 in identifying autism among adults with complex psychiatric conditions. Journal of autism and developmental disorders , 47 (9), 2703-2709.
Baghdadli, A., Russet, F., & Mottron, L. (2017). Measurement properties of screening and diagnostic tools for autism spectrum adults of mean normal intelligence: A systematic review. European Psychiatry , 44 , 104-124.
Wigham, S., Rodgers, J., Berney, T., Le Couteur, A., Ingham, B., & Parr, J. R. (2019). Psychometric properties of questionnaires and diagnostic measures for autism spectrum disorders in adults: A systematic review. Autism , 23 (2), 287-305.
Lee, D., Frey, G., Cheng, A., & Shih, P. C. (2018, September). Puzzle walk: A gamified mobile app to increase physical activity in adults with an autism spectrum disorder. In 2018 10th International Conference on Virtual Worlds and Games for Serious Applications (VS-Games) (pp. 1-4). IEEE.
Tromans, S., Yao, G. L., Kiani, R., Alexander, R., Al-Uzri, M., & Brugha, T. (2019). Study protocol: an investigation of the prevalence of autism among adults admitted to acute mental health wards: a cross-sectional pilot study. BMJ Open , 9 (12).
