Background: Research highlights that access to support services after a diagnosis of autism in adulthood is limited, but few studies have investigated possible solutions to this problem. We explored the experiences of survey respondents receiving or providing an autism diagnosis in adulthood, identified support, and examined characteristics of valued or desired support, in the context of limited-service provision.Methods: We surveyed autistic adults, relatives, and clinicians about experiences of UK adult post-autism diagnosis support and services within 12 months following diagnostic assessment. We used thematic analysis with a hybrid deductive/inductive approach; we defined broad a priori themes and triangulated respondents' perspectives and views.Results: In total, 343 autistic adults, 45 relatives, and 35 clinicians completed parallel surveys. We defined four superordinate themes: (1) using networks post-diagnosis to make changes, (2) characteristics of effective and acceptable support solutions, (3) making autism support better informed, and (4) ways of addressing perceived gaps in support services.Conclusions: We have described examples of support leading to positive change and constructive recommendations that can guide and inform quality improvement activities by (1) those commissioning and providing adult post-autism diagnosis support and (2) professionals evaluating provision, to enhance evidence-based post-diagnostic support services. Community Brief Why is this an important issue? There are limited supports and services for autistic people after they receive a diagnosis in adulthood. While research has focused on deficits in support and service provision, less research has examined positive experiences and solutions. What was the purpose of this study? We wanted to explore the views of autistic adults, relatives, and clinicians involved in providing diagnostic services. In particular, we wanted to know what post-diagnosis support service has worked well and what could work better by asking people about their experiences. What did the researchers do? We surveyed 343 autistic adults, 45 relatives, and 35 clinicians about their experience of support for autistic people after diagnosis in adulthood. We looked at what they said to find themes about what happened after an autism diagnosis. We also explored themes about positive experiences of support and possible solutions alongside descriptions of gaps in service provision and suggestions and recommendations for improvements to available support. What were the results of the study? We found the views of the autistic adults, relatives and clinicians could be grouped into four key areas or themes. The first theme described how community networks could be used to make changes after diagnosis. The second theme described support solutions. Examples included individualized support, psychoeducation, and support for autistic carers, families and relatives. Thirdly, we found a focus on autism experts, training and integrating support within specialist and mainstream settings. Lastly, we identified a theme which described ways of improving access to community resources and opportunities. What do these findings add to what was already known? We identified recommendations for ways of improving support and services based on what autistic people, families and clinicians told us. One example was finding ways of sharing information from diagnostic reports about strengths, difficulties and reasonable adjustments with healthcare staff or employers. The examples of support we identified that led to positive change can be used by healthcare and other providers to enhance post-diagnostic support provision. What are potential weaknesses in the study? The respondents we surveyed had recently received an autism diagnosis (during the 5 years before the study started) and described their experience of support in the year after diagnosis. Attitudes of autistic adults and relatives to receiving an autism diagnosis and accessing support and services may change over time with transitions and life experiences. The views of participants we surveyed may therefore not represent the experiences of autistic adults and relatives at other life-course stages. How will these findings help autistic adults now or in the future? A greater understanding of direct experiences of service users, relatives and clinicians, including learning about the positive experiences and recommendations we identified can be used to help shape support and services for autistic adults now and in the future.

Anxiety is commonly experienced by autistic people and impacts on quality of life and social participation. New anxiety interventions are required to effectively meet the needs of autistic people. Personalised Anxiety Treatment-Autism (PAT-A©) is a bespoke, modular approach to treating anxiety in up to 12 sessions. This study explored the feasibility and acceptability of delivering PAT-A© in the UK National Health Service (NHS). A single-blind randomised controlled trial design. Thirty-four autistic adults were recruited via clinical services and randomised to receive either PAT-A© or enhanced treatment as usual (CCSP). Outcome assessments relating to anxiety, quality of life and related constructs were completed at baseline, immediately post intervention; and at 3 and 12 months. Seventy-one percent of the PAT-A© group and 65% of the CCSP met diagnostic threshold for at least three anxiety disorders. Retention was good across both groups, with 82% (N = 14/17) completing the full course of PAT-A© and 71% (N = 12/17) attending both psychoeducational sessions in CCSP. 94% in PAT-A© and 82% in CCSP completed some follow up assessment 3 months post-intervention. Thematic analysis of interview data revealed that many participants valued the personalised approach, developed transferable skills and experienced positive changes to their anxiety. Participants were willing to be recruited and randomised, PAT-A© was feasible to deliver in the NHS and the trial methods and materials were acceptable. Our findings indicate that a fully powered clinical and cost-effectiveness trial of PAT-A© is warranted.

In this study we explored the risks, benefits and clinical implications of administering cognitive assessments within a UK based Child and Adolescent attention deficit hyperactivity disorder (ADHD) diagnostic service. Ten mental health professionals were interviewed with data analysed using thematic analysis.

Background Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment–Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. Methods/design This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important ‘target situations’ that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. Discussion This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people. Trial registration ISRCTN, ID: 15881562 . Retrospectively registered on 9 August 2019.

ObjectivesTo assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.SettingPopulation based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).ParticipantsUnder-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.Primary outcome measureAntidepressant prescription rates per month per 100 000 depressed 4–17 year olds.ResultsFollowing the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend −12.34 (95% CI −18.67 to −6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (β for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low.ConclusionsDespite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.

Background: Restricted and Repetitive Behaviours (RRBs) are some of the most difficult behaviours to manage in children with Autism Spectrum Disorders (ASD). Although RRBs frequently occur in educational settings, we know little about the way in which teachers understand these behaviours. Aims: The study aimed to explore the attributions, emotional response and feelings of confidence held by teachers working in different educational settings when faced with RRBs. Methods and procedures: A single group survey design using behavioural vignettes was adopted in order to elicit teacher beliefs and ratings. Outcomes and results: Analysis indicated that there were differences in the attributions and confidence ratings held for different types of RRBs. Significant differences were also observed between teachers working in mainstream and specialist educational settings. Emotional response and confidence scores were often predictive of one another alongside factors related to teaching experience. Conclusion and implications: The findings indicate that teachers from mainstream schools potentially hold less helpful beliefs in response to RRBs and therefore are a professional group who may benefit the most from additional support and training. Further research could consider conducting a qualitative exploration of why teachers hold certain beliefs about RRBs and/or sampling those who are less experienced in working with children with ASD.

Attention-Deficit Hyperactive Disorder (ADHD) is one of the most common mental health disorders amongst school-aged children with an estimated prevalence of 5% in the global population (American Psychiatric Association, 2013). Stimulants, particularly methylphenidate (MPH), are the first-line option in the treatment of ADHD (Reeves and Schweitzer, 2004; Dopheide and Pliszka, 2009) and are prescribed to an increasing number of children and adolescents in the US and the UK every year (Safer et al., 1996; McCarthy et al., 2009), though recent studies suggest that this is tailing off, e.g., Holden et al. (2013). Around 70% of children demonstrate a clinically significant treatment response to stimulant medication (Spencer et al., 1996; Schachter et al., 2001; Swanson et al., 2001; Barbaresi et al., 2006). However, it is unclear which patient characteristics may moderate treatment effectiveness. As such, most existing research has focused on investigating univariate or multivariate correlations between a set of patient characteristics and the treatment outcome, with respect to dosage of one or several types of medication. The results of such studies are often contradictory and inconclusive due to a combination of small sample sizes, low-quality data, or a lack of available information on covariates. In this paper, feature extraction techniques such as latent trait analysis were applied to reduce the dimension of on a large dataset of patient characteristics, including the responses to symptom-based questionnaires, developmental health factors, demographic variables such as age and gender, and socioeconomic factors such as parental income. We introduce a Bayesian modeling approach in a "learning in the model space" framework that combines existing knowledge in the literature on factors that may potentially affect treatment response, with constraints imposed by a treatment response model. The model is personalized such that the variability among subjects is accounted for by a set of subject-specific parameters. For remission classification, this approach compares favorably with conventional methods such as support vector machines and mixed effect models on a range of performance measures. For instance, the proposed approach achieved an area under receiver operator characteristic curve of 82-84%, compared to 75-77% obtained from conventional regression or machine learning ("learning in the data space") methods.

Child and Adolescent Mental HealthVolume 21, Issue 2 p. 136-136 Book News Psychosis in childhood and adolescence J.B. McCarthy (Ed.) London: Routledge, 2014. pp. 238, £25.99 (pb). ISBN: 978-0-415-82106-3. Patrick Welsh, Patrick Welsh Tees, Esk and Wear Valleys NHS Foundation Trust, UKSearch for more papers by this author Patrick Welsh, Patrick Welsh Tees, Esk and Wear Valleys NHS Foundation Trust, UKSearch for more papers by this author First published: 19 April 2016 https://doi.org/10.1111/camh.12134Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume21, Issue2May 2016Pages 136-136 RelatedInformation

This study compares the self‐reported family functioning of 21 adolescents presenting at four UK medical wards with self‐harming behaviour with those obtained from a sample of adolescents drawn from the local community. Adolescents hospitalized for self‐harm reported that their families were more dysfunctional than healthy controls on the family perceptions scale. However, this difference was not observed when covariates such as emotional and behavioural distress were controlled for. Poor levels of agreement between adolescents and adult family members in relation to family perceptions were also observed. The findings suggest that adolescents who engage in significant self‐harm perceive impairments in their family functioning. These reported impairments may be the result of concurrent emotional and behavioural distress or some form of interaction between family functioning and distress. A comprehensive family assessment to detect absolute changes and disparities in perceived family functioning may therefore help guide family interventions in this context.Practitioner points Adolescents who are hospitalized for self‐harm report significant impairments in family functioning compared with healthy controls. Adolescent and adult family members appear to disagree on the degree of impaired family functioning. A comprehensive family assessment may therefore help guide family interventions in hospitalized adolescents.

Few studies relating to youth mental health have actively involved young people in the design and conduct of research.

BACKGROUND:Patient and Public Involvement is now an essential part of health-related research. Evidence suggests that research that involves patients and members of the public can enhance methodological rigor and facilitate the implementation of research findings.AIMS:Our paper describes the development of a youth research group (Youth Speak) aimed at increasing youth engagement in mental health research.METHOD:We provide a selective review of the literature and outline the challenges and benefits of involving young people in research. Examples of how our group has facilitated involvement and the challenges we have encountered are also discussed.RESULTS:Meaningful involvement of young people in mental health research is poorly documented or significantly lacking given the dearth of published literature. This may reflect the difficulty of obtaining sustained funding which is required to facilitate non-tokenistic involvement or a perception that young people are unable to provide meaningful contributions in this area.CONCLUSIONS:By establishing groups such as Youth Speak, which focus on the long-term involvement and development of young people in all stages of the research process, we hope to empower young people so that they can reshape youth mental health services.

First person accounts are recognised as important educational and self-exploratory approaches. However accounts from adolescents with psychotic-like experiences are largely absent in comparison to other areas of adolescent and adult psychiatry. In this opinion piece we discuss the importance of adolescent accounts and how they may be collected and used within and outside of mental health services.

Despite increased efforts over the last decade to prospectively identify individuals at ultra-high risk of developing a psychotic illness, limited attention has been specifically directed towards adolescent populations (<18 years). In order to evaluate how those under 18 fulfilling the operationalised criteria for an At-Risk Mental State (ARMS) present and fare over time, we conducted an observational study. Participants (N = 30) generally reported a high degree of functional disability and frequent and distressing perceptual disturbance, mainly in the form of auditory hallucinations. Seventy percent (21/30) were found to fulfil the criteria for a co-morbid ICD-10 listed mental health disorder, with mood (affective; 13/30) disorders being most prevalent. Overall transition rates to psychosis were low at 24 months follow-up (2/28; 7.1 %) whilst many participants demonstrated a significant reduction in psychotic-like symptoms. The generalisation of these findings may be limited due to the small sample size and require replication in a larger sample.

The following hypothesis explores the possibility of using behavioural activation therapy for adolescents with an at-risk mental state for psychosis. Support is drawn from psychosis-related survey and pilot data as well as a robust evidence base for adult depression. However, we acknowledge that extensive feasibility work is required before exploring this hypothesis further.

The self‐regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at‐risk mental state (ARMS) for psychosis is limited.

In this article we examine the identification of young people deemed to be at an elevated risk of developing psychosis (often referred to as an At-Risk Mental State for psychosis). Although this is not a new concept within psychiatry, there has been a growing interest in this topic because of the proposed inclusion of an official Psychosis Risk Syndrome' in the 2013 Diagnostic and Statistical Manual. Although we discuss the risks and benefits associated with the categorisation of individuals based on the concept of risk itself, we also draw upon observations from one of our own research studies. We interviewed six adolescents with an identified At-Risk Mental State analysing the data using an Interpretative Phenomenological Analysis framework. We identified three key themes: It is better to say it', How others would take me' and Just to have somebody to talk to'. Within these themes, participants endorsed risk identification as a means of personally justifying and explaining their current symptoms, as well as providing a sense of optimism that their condition was not yet fully formed. Concerns regarding stigmatisation were identified although rarely experienced. These findings indicate that there are indeed personal benefits for screening for psychosis risk in young people, despite the undesirability' of identification reported in other areas of health. The benefits observed may reflect genuine differences in adolescent mental health or the methodological constraints of this exploratory study. Nevertheless, the results contribute to the understanding and ongoing debate of screening for illness in potential at-risk' populations.