Hostname: page-component-6b989bf9dc-md2j5 Total loading time: 0 Render date: 2024-04-15T00:25:14.849Z Has data issue: false hasContentIssue false

Diagnosing autism spectrum disorders in elderly people

Published online by Cambridge University Press:  29 November 2010

Maarten E.H. van Niekerk*
Affiliation:
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands Pro Persona, Nijmegen Mental Health Centre, The Netherlands
Wouter Groen
Affiliation:
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands
Constance Th.W.M. Vissers
Affiliation:
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
Dorine van Driel-de Jong
Affiliation:
Pro Persona, Nijmegen Mental Health Centre, The Netherlands
Cees C. Kan
Affiliation:
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands
Richard C. Oude Voshaar
Affiliation:
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
*
Correspondence should be addressed to: Maarten E. H. van Niekerk, MD, University Medical Center Nijmegen, Department of Psychiatry (333), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31 (0)24–3617197; Fax: +31 (0)24–3617855. Email: meh.niekerk@psy.umcn.nl.

Abstract

Background: As autism spectrum disorders (ASD) have largely been neglected in old-age psychiatry, the objective of the present paper is to describe the diagnostic process in elderly patients.

Methods: A systematic review of the literature on ASD in older age was undertaken and illustrated by a case series of three elderly patients first diagnosed with ASD in later life by a tertiary mental health clinic.

Results: The search of the literature only yielded three papers on late-life ASD, while the review of the available diagnostic procedures among adults suggests some relevance for screening instruments (Autism Questionnaire), diagnostic instruments (Module 4, Autism Diagnostic Observation Schedule), and neuropsychological examination to profile impairments. Nonetheless, the case reports clearly showed that taking a thorough history with the patient, corroborated and supplemented by a close relative or caregiver who has known the patient for at least ten years, still remains the most important diagnostic tool.

Conclusion: The three case studies show that in clinical practice ASD can easily be missed in elderly individuals presenting with comorbid psychiatric disorders, potentially causing iatrogenic damage. Although further research on phenotyping and diagnosing ASD in older people is warranted, the most important step at this point is to create a greater awareness of the possibility of ASD in old age among health-care professionals working with people in this age group.

Type
Review Article
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baird, G. et al. (2000). A screening instrument for autism at 18 months of age: a 6-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694702.CrossRefGoogle ScholarPubMed
Baron-Cohen, S. (1989). Do autistic children have obsessions and compulsions? British Journal of Clinical Psychology, 28, 193200.CrossRefGoogle ScholarPubMed
Baron-Cohen, S. and Wheelwright, S. (2004). The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34, 163175.CrossRefGoogle ScholarPubMed
Baron-Cohen, S., O'Riordan, M., Stone, V., Jones, R. and Plaisted, K. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 29, 407418.CrossRefGoogle ScholarPubMed
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J. and Clubley, E. (2001a). The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 517.CrossRefGoogle ScholarPubMed
Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y. and Plumb, I. (2001b). The “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry, 42, 241251.CrossRefGoogle ScholarPubMed
Bastiaansen, J. A. C. J. et al. (2010). Diagnosing autism spectrum disorders in adults: the use of ADOS Module 4. Unpublished paper. BCN NeuroImaging Center, University of Groningen, The Netherlands.Google Scholar
Beaumont, R. and Newcombe, P. (2006). Theory of mind and central coherence in adults with high-functioning autism or Asperger syndrome. Autism, 10, 365382.CrossRefGoogle ScholarPubMed
Berg, E. A. (1948). A simple objective technique for measuring flexibility in thinking. Journal of General Psychology, 39, 1522.CrossRefGoogle ScholarPubMed
Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsopp, M. and Decoufle, P. (2001). Prevalence of autism in Brick Township, New Jersey: investigation. Pediatrics, 108, 11551161.CrossRefGoogle ScholarPubMed
Berument, S. K., Rutter, M., Lord, C., Pickles, A. and Bailey, A. (1999). Autism screening questionnaire: diagnostic validity. British Journal of Psychiatry, 175, 444451.CrossRefGoogle ScholarPubMed
Bhaumik, S., Tyrer, F., Barrett, M., Tin, N., McGrother, C. W. and Kiani, R. (2010). The relationship between carers' report of autistic traits and clinical diagnoses of autism spectrum disorders in adults with intellectual disability. Research in Developmental Disabilities, 31, 705712.CrossRefGoogle ScholarPubMed
Brüne, M. and Brüne-Cohrs, U. (2006). Theory of mind-evolution, ontogeny, brain mechanisms and psychopathology. Neuroscience and Biobehavioral Reviews, 30, 437455.CrossRefGoogle ScholarPubMed
Castelli, F., Frith, C., Happé, F. and Frith, U. (2002). Autism, Asperger syndrome and brain mechanisms for the attribution of mental states to animated shapes. Brain, 125, 18391849.CrossRefGoogle ScholarPubMed
Dawson, M., Soulières, I., Gernsbacher, M. A. and Mottron, L. (2007). The level and nature of autistic intelligence. Psychological Science, 18, 657662.CrossRefGoogle ScholarPubMed
de Bildt, B. A. et al. (2004). Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. Journal of Autism and Developmental Disorders, 34, 129137.CrossRefGoogle ScholarPubMed
Fombonne, E. (1999). The epidemiology of autism: a review. Psychological Medicine, 29, 769786.CrossRefGoogle ScholarPubMed
Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65, 591598.CrossRefGoogle ScholarPubMed
Frith, U. and Happé, F. (1994). Language and communication in autistic disorders. Philosophical Transactions of the Royal Society B: Biological Sciences, 346, 97104.Google ScholarPubMed
Gaudino, E. A., Geisler, M. W. and Squires, N. K. (1995). Construct validity in the Trail Making Test: what makes Part B harder? Journal of Clinical and Experimental Neuropsychology, 17, 529535.CrossRefGoogle ScholarPubMed
Gillberg, C. and Billstedt, E. (2000). Autism and Asperger syndrome: coexistence with other clinical disorders. Acta Psychiatrica Scandinavica, 102, 321330.CrossRefGoogle ScholarPubMed
Gotham, K., Risi, S., Pickles, A. and Lord, C. (2007). The Autism Diagnostic Observation Schedule: revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613627.CrossRefGoogle ScholarPubMed
Hansman-Wijnands, M. A. and Hummelen, J. W. (2006). Differential diagnosis of psychopathy and autism spectrum disorders in adults: empathic deficit as a core symptom. Tijdschrift voor Psychiatrie, 48, 627636.Google ScholarPubMed
Happé, F. (1994). An advanced test of theory of mind: understanding of story character thoughts and feelings by able autistic mentally handicapped and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129154.CrossRefGoogle ScholarPubMed
Happé, F. and Frith, U. (2006). The weak coherence account: detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 525.CrossRefGoogle ScholarPubMed
Heavey, L., Phillips, W., Baron-Cohen, S. and Rutter, M. (2000). The Awkward Moments Test: a naturalistic measure of social understanding in autism. Journal of Autism and Developmental Disorders, 30, 225236.CrossRefGoogle Scholar
Heijnen-Kohl, S. M. and van Alphen, S. P. (2009). Diagnosis of autism spectrum disorders in older adults. Tijdschrift voor Psychiatrie, 51, 339343.Google ScholarPubMed
Hoekstra, R. A., Bartels, M., Cath, D. C. and Boomsma, D. I. (2008). Factor structure, reliability and criterion validity of the Autism-Spectrum Quotient (AQ): a study in Dutch population and patient groups. Journal of Autism and Developmental Disorders, 38, 15551566.CrossRefGoogle ScholarPubMed
Howlin, P., Goode, S., Hutton, J. and Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45, 212229.CrossRefGoogle ScholarPubMed
James, I. A., Mukaetova-Ladinska, E., Reichelt, F. K., Briel, R. and Scully, A. (2006). Diagnosing Asperger's syndrome in the elderly: a series of case presentations. International Journal of Geriatric Psychiatry, 21, 951960.CrossRefGoogle ScholarPubMed
Kan, C. C., Buitelaar, J. K. and van der Gaag, R. J. (2008). Autism spectrum disorders in adults. Nederlands Tijdschrift voor Geneeskunde, 152, 13651369.Google ScholarPubMed
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217250.Google Scholar
Kenworthy, L., Yerys, B. E., Gutermuth Anthony, L. and Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18, 320338.CrossRefGoogle ScholarPubMed
Kertesz, A., Davidson, W., McCabe, P., Takagi, K. and Munoz, D. (2003). Primary progressive aphasia: diagnosis, varieties, evolution. Journal of the International Neuropsychology Society, 9, 710719.CrossRefGoogle ScholarPubMed
Kissgen, R. and Schleiffer, R. (2002). Specificity hypothesis of a theory of mind deficit in early childhood autism. Zeitschrift fűr Kinder- und Jugendpsychiatrie und Psychotherapie, 30, 2940.Google ScholarPubMed
Kurita, H., Koyama, T. and Osada, H. (2005). Autism-Spectrum Quotient-Japanese version and its short forms for screening normally intelligent persons with pervasive developmental disorders. Psychiatry and Clinical Neurosciences, 59, 490496.CrossRefGoogle ScholarPubMed
Lawson, J., Baron-Cohen, S. and Wheelwright, S. (2004). Empathising and systemising in adults with and without Asperger Syndrome. Journal of Autism and Developmental Disorders, 34, 301310.CrossRefGoogle ScholarPubMed
Lord, C., Rutter, M. and Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659685.CrossRefGoogle ScholarPubMed
Lord, C. et al. (2000). The Autism Diagnostic Observation Schedule-Generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205223.CrossRefGoogle ScholarPubMed
Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A. and Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63, 694701.CrossRefGoogle ScholarPubMed
Mendez, M. F., Clark, D. G., Shapira, J. S. and Cummings, J. L. (2003). Speech and language in progressive nonfluent aphasia compared with early Alzheimer's disease. Neurology, 61, 11081113.CrossRefGoogle ScholarPubMed
Murray, H. A. (1943). Thematic Apperception Test Manual. Cambridge, MA: Harvard University Press.Google Scholar
Naidu, A., James, I., Mukaetova-Ladinska, E. and Briel, R. (2006). Diagnosis of Asperger's syndrome in a 66-year-old male presenting with depression. International Psychogeriatrics, 18, 171173.CrossRefGoogle Scholar
Nordin, V. and Gillberg, C. (1998). The long-term course of autistic disorders: update on follow-up studies. Acta Psychiatrica Scandinavica, 97, 99108.CrossRefGoogle ScholarPubMed
Nylander, L. and Gillberg, C. (2001). Screening for autism spectrum disorders in adult psychiatric out-patients: a preliminary report. Acta Psychiatrica Scandinavica, 103, 428434.CrossRefGoogle ScholarPubMed
Osterrieth, P. A. (1944). Le test de copie d'une figure complexe. Archives de Psychologie, 30, 206356.Google Scholar
Ozonoff, S., Pennington, B. F. and Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: relationship to theory of mind. Journal of Child Psychology and Psychiatry, 32, 10811105.CrossRefGoogle ScholarPubMed
Ozonoff, S., Garcia, N., Clark, E. and Lainhart, J. E. (2005). MMPI-2 personality profiles of high-functioning adults with autism spectrum disorders. Assessment, 12, 8695.CrossRefGoogle ScholarPubMed
Perry, D. W., Marston, G. W., Hinder, S. A., Munden, A. C. and Roy, A. (2001). The phenomenology of depressive illness in people with learning disability and autism. Autism, 5, 265275.CrossRefGoogle ScholarPubMed
Reichow, B. and Volkmar, F. R. (2010). Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40, 149166.CrossRefGoogle Scholar
Rey, A. (1941). L'examen psychologique dans les cas d'encephalopathie traumatique. Archives de Psychologie, 28, 286340.Google Scholar
Rhee, J., Antiquena, P. and Grossman, M. (2001). Verb comprehension in frontotemporal degeneration: the role of grammatical, semantic and executive components. Neurocase, 7, 173184.CrossRefGoogle ScholarPubMed
Schlooz, et al. (2006). Fragmented visuospatial processing in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 10251037.CrossRefGoogle ScholarPubMed
Seltzer, M. M., Shattuck, P., Abbeduto, L. and Greenberg, J. S. (2004). Trajectory of development in adolescents and adults with autism. Mental Retardation and Developmental Disabilities Research Reviews, 10, 234247.CrossRefGoogle ScholarPubMed
Sizoo, B., van den Brink, W., Gorissen van Eenige, M. and van der Gaag, R. J. (2009). Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders. Journal of Nervous and Mental Disease, 197, 450454.CrossRefGoogle ScholarPubMed
Skuse, D. et al. (2004). The Developmental, Dimensional and Diagnostic Interview (3di): a novel computerized assessment for autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 548558.CrossRefGoogle ScholarPubMed
Teunisse, J. P. and de Gelder, B. (2003). Face processing in adolescents with autistic disorder: the inversion and composite effects. Brain and Cognition, 52, 285294.CrossRefGoogle ScholarPubMed
Wimmer, H. and Perner, J. (1983). Beliefs about beliefs: representation and constraining function of wrong beliefs in young children's understanding of deception. Cognition, 13, 103128.CrossRefGoogle ScholarPubMed
Wing, L., Leekam, S. R., Libby, S. J., Gould, J. and Larcombe, M. (2002). The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry, 43, 307325.CrossRefGoogle ScholarPubMed
Witkin, H. A., Dyck, R. B., Faterson, H. F., Goodenough, D. G. and Karp, S. A. (1962). Personality through Perception. New York: Harper and Row.Google Scholar