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Deterioration is clearest among families already struggling

Background Current global estimates suggest the proportion of the population with autism spectrum disorder (ASD) who have intellectual disability (ID) is approximately 50%. Our objective was to ascertain the existence of selection bias due to under-inclusion of populations with ID across all fields of autism research. A sub-goal was to evaluate inconsistencies in reporting of findings. Methods This review covers all original research published in 2016 in autism-specific journals with an impact factor greater than 3. Across 301 included studies, 100,245 participants had ASD. A random effects meta-analysis was used to estimate the proportion of participants without ID. Selection bias was defined as where more than 75% of participants did not have ID. Results Meta-analysis estimated 94% of all participants identified as being on the autism spectrum in the studies reviewed did not have ID (95% CI 0.91–0.97). Eight out of ten studies demonstrated selection bias against participants with ID. The reporting of participant characteristics was generally poor: information about participants’ intellectual ability was absent in 38% of studies ( n  = 114). Where there was selection bias on ID, only 31% of studies mentioned lack of generalisability as a limitation. Conclusions We found selection bias against ID throughout all fields of autism research. We recommend transparent reporting about ID and strategies for inclusion for this much marginalised group.

The immediate response to the Covid-19 pandemic saw school closures and a shift in provision to online health services for children and young people experiencing mental health concerns. This study provides mental health and referral services with an insight into difficulties experienced as well as recommendations on potential improvements. Semi-structured interviews with 11 parents and six young people. Reflexive thematic analysis was used to analyse the data. Parents and young people reported mixed experiences on accessing mental health support. Priorities and pressures on health services impacted the likelihood of choosing to seek and being able to obtain help. Parents and young people had varying expectations and experiences in help-seeking during the pandemic which were also impacted by others' experiences and views. For many, the relationship with the professional they were in contact with impacted their mental health treatment. Provision was sometimes accessed via private services due to long waiting lists or problems that did not \"meet threshold\". Understanding the experiences of seeking mental healthcare during the pandemic can inform improvements to access to services at a time when people are most vulnerable. Accessible provision other than private services needs to be made for those on waiting lists. For those who do not meet service threshold, intermediary support needs to be secured to prevent unnecessary exacerbation of symptoms and prolonged problems. If schools are to remain the hub for children and young people's mental health services, they should be considered essential services at all times.

Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear. The current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK. Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association. Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association. Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.

The UK prevalence of parent-reported autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) were estimated from the Millennium Cohort Study. Case definition was if a doctor or health care professional had ever told parents that their child had ASD and/or ADHD. Data were collected in 2008/2009 for 14,043 children. 1.7 % of children were reported as having ASD (95 % CI 1.4–2.0) at mean age 7.2 years (SD = 0.2; range = 6.3–8.2). 1.4 % reportedly had ADHD (95 % CI 1.2–1.7), and 0.3 % had both ASD and ADHD (95 % CI 0.2–0.5). After adjusting for socio-economic disadvantage, only male sex ( p  < 0.001 for both conditions) and cognitive ability, p  = 0.004 (ASD); p  = 0.01 (ADHD) remained strongly associated. The observed prevalence of parent-reported ASD is high compared to earlier UK and US estimates. Parent-reported ADHD is low compared to US estimates using the same measure.

The COVID-19 pandemic and ensuing social restrictions disrupted young people’s social interactions and resulted in several periods during which school closures necessitated online learning. We hypothesised that digitally excluded young people would demonstrate greater deterioration in their mental health than their digitally connected peers during this time. We analysed representative mental health data from a sample of UK 10–15-year-olds (N = 1387) who completed a mental health inventory in 2017–2019 and thrice during the pandemic (July 2020, November 2020 and March 2021). We employed longitudinal modelling to describe trajectories of adolescent mental health for participants with and without access to a computer or a good internet connection for schoolwork. Adolescent mental health symptoms rose early in the COVID-19 pandemic, with the highest mean Total Difficulties score around December 2020. The worsening and subsequent recovery of mental health during the pandemic was greatly pronounced among those without access to a computer, although we did not find evidence for a similar effect among those without a good internet connection. We conclude that lack of access to a computer is a tractable risk factor that likely compounds other adversities facing children and young people during periods of social isolation or educational disruption.

An increased understanding of the interrelations between depressive symptoms among older populations could help improve interventions. However, studies often use sum scores to understand depression in older populations, neglecting important symptom dynamics that can be elucidated in evolving depressive symptom networks. We computed Cross-Lagged Panel Network Models (CLPN) of depression symptoms in 11,391 adults from the English Longitudinal Study of Ageing. Adults aged 50 and above (mean age 65) were followed over 16 years throughout this nine-wave representative population study. Using the eight-item Center for Epidemiological Studies Depression Scale, we computed eight CLPNs covering each consecutive wave. Across waves, networks were consistent with respect to the strength of lagged associations (edge weights) and the degree of interrelationships among symptoms (centrality indices). Everything was an effort and could not get going displayed the strongest reciprocal cross-lagged associations across waves. These two symptoms and loneliness were core symptoms as reflected in strong incoming and outgoing connections. Feeling depressed was strongly predicted by other symptoms only (incoming but not strong outgoing connections were observed) and thus was not related to new symptom onset. Restless sleep had outgoing connections only and thus was a precursor to other depression symptoms. Being happy and enjoying life were the least central symptoms. This research underscores the relevance of somatic symptoms in evolving depression networks among older populations. Findings suggest the central symptoms from the present study (everything was an effort, could not get going, loneliness) may be potential key intervention targets to mitigate depression in older adults.

Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. To examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.

Background Research suggests that diagnostic procedures for Autism Spectrum Disorder are not consistent across practice and that diagnostic rates can be affected by contextual and social drivers. The purpose of this review was to consider how the content of clinical practice guidelines shapes diagnoses of Autism Spectrum Disorder in the UK; and investigate where, within those guidelines, social factors and influences are considered. Methods We electronically searched multiple databases (NICE Evidence Base; TRIP; Social Policy and Practice; US National Guidelines Clearinghouse; HMIC; The Cochrane Library; Embase; Global health; Ovid; PsychARTICLES; PsychINFO) and relevant web sources (government, professional and regional NHS websites) for clinical practice guidelines. We extracted details of key diagnostic elements such as assessment process and diagnostic tools. A qualitative narrative analysis was conducted to identify social factors and influences. Results Twenty-one documents were found and analysed. Guidelines varied in recommendations for use of diagnostic tools and assessment procedures. Although multidisciplinary assessment was identified as the ‘ideal’ assessment, some guidelines suggested in practice one experienced healthcare professional was sufficient. Social factors in operational, interactional and contextual areas added complexity to guidelines but there were few concrete recommendations as to how these factors should be operationalized for best diagnostic outcomes. Conclusion Although individual guidelines appeared to present a coherent and systematic assessment process, they varied enough in their recommendations to make the choices available to healthcare professionals particularly complex and confusing. We recommend a more explicit acknowledgement of social factors in clinical practice guidelines with advice about how they should be managed and operationalised to enable more consistency of practice and transparency for those coming for diagnosis.