Risk markers for suicidality in autistic adults.

BACKGROUND: Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. METHODS: Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. RESULTS: A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. CONCLUSIONS: Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed

Term admissions to neonatal intensive care unit : a Maltese observational study

Objective: This study aimed to identify the number of term infants admitted to the Maltese Neonatal and Paediatric Intensive Care Unit (NPICU) between January and June 2016, as well as factors contributing to their admission. Methods: All term infants (37+ weeks gestation) born in January-June 2016, transferred from Central Delivery Suite or Obstetric Wards to NPICU were identified. Patient registers, electronic case summaries, and the National Obstetric Information System (NOIS) database were used, with approval from the Data Protection Office, to collect data for a retrospective case control study. Results: Of the term infants born in these 6 months, 5.2% (101) were admitted to NPICU resulting in 42.6% of all admissions. The mean gestational age was 39 weeks (95% CI 38.8, 39.3) and mean birth weight was 3.3kg (95% CI 3.2, 3.4). More than half had been born by elective and emergency Caesarean section (26% and 27% respectively). Commonest reason for admission was respiratory distress (37%). Others included non-bilious vomiting (20%), congenital abnormalities (13%), hyperbilirubinaemia (8%), and infection (4%). Statistically significant factors associated with admission were operative delivery, threatened abortion and maternal infection during pregnancy, maternal insulin dependent diabetes mellitus, and low Apgar scores. Conclusion: The significant contributing factors should be targeted and further evaluation over a longer time-frame with an interdisciplinary team carried out in an effort to reduce rate of admissions and improve quality of care.peer-reviewe

Revised Children’s Anxiety and Depression Scale (RCADS): Psychometric Properties in a Clinical Sample in the United Kingdom

© 2021 Baron I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.Background: Routine Outcome monitoring has become a principle element in the transformation of mental health services for children and young people in the UK and promoted by the CYP Improving Access to Psychological Therapies (IAPT) program. Collecting data on the outcome of therapeutic interventions is a required element of the mental health data set within NHS settings. The Revised Child’s Anxiety and Depression Scale (RCADS) has been identified as a useful tool based on the normative studies of US populations. There has, however, been no evaluation of RCADS for a UK population. Because of the data available, the current study provides an initial assessment of the validity and reliability of the RCADS in a United Kingdom (UK) clinical sample. Children had been referred to a community mental health and emotional wellbeing service for children and young people presenting with mild to moderate difficulties, in the East of England. Methods: A sample of 1920 CYP (equivalent numbers of boys and girls, aged 7.9 to 18 years), completed the RCADS as part of routine assessment. Parents also completed the RCADS-P for comparison. Tests of normality, internal consistency, factor analysis and correlation were conducted on child and parent raw scores. Results: The current study identified the psychometric properties of RCADS for a UK clinical sample. RCADS showed a simple structure where all six variables loaded highly on the one factor of Separation Anxiety. RCADS showed good internal consistency with positive and highly significant correlations between subscales as well as between child and parents reports. Conclusions: All six subscales were found to be necessary part of RCADS. Indications are that RCADS shows promising clinical utility as a valid and reliable measure for assessing children with Anxiety and Depression in the UK. Future research needs to include a confirmatory factor analysis and assessment of a reliable clinical cut off-score for a UK clinical population.Peer reviewe

'People like me don't get support': Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality.

Autistic people are at high risk of mental health problems, self-injury and suicidality. However, no studies have explored autistic peoples' experiences of treatment and support for these difficulties. In partnership with a steering group of autistic adults, an online survey was developed to explore these individuals' experiences of treatment and support for mental health problems, self-injury and suicidality for the first time. A total of 200 autistic adults (122 females, 77 males and 1 unreported) aged 18-67 (mean = 38.9 years, standard deviation = 11.5), without co-occurring intellectual disability, completed the online survey. Thematic analysis of open-ended questions resulted in an overarching theme that individually tailored treatment and support was both beneficial and desirable, which consisted of three underlying themes: (1) difficulties in accessing treatment and support; (2) lack of understanding and knowledge of autistic people with co-occurring mental health difficulties and (3) appropriate treatment and support, or lack of, impacted autistic people's well-being and likelihood of seeing suicide as their future. Findings demonstrate an urgent need for autism treatment pathways in mental health services

Developing Proactive Methods for General Aviation Data Collection

Introduction. Over the last 20 years, nearly 40,000 general aviation (GA) aircraft were involved in accidents, roughly 20% of which were fatal. To address this safety concern, scientists have often relied on accident data. Because of the rare nature of accidents, commercial aviation incident and near miss data may prove to be useful sources of safety information. In one such study, the National Transportation Safety Board interviewed GA pilots that were flying near a weather-related accident in pursuit of a different perspective than that of the accident pilot. Interviewing GA pilots about their own weather-related event may provide similar benefits. Method. To understand factors leading GA pilots to encounter adverse weather conditions, pilots involved in an adverse weather encounter were interviewed using a one-hour structured interview. The interview was developed using surveys utilized by National Aeronautics and Space Administration and the Federal Aviation Administration (FAA). In total, 27 pilots who experienced an adverse weather encounter were interviewed, of which 25 were included in the final analysis. Results. Previous studies conducted by the FAA and others found many GA accidents involving flight into adverse weather were categorized as a willful disregard for the rules and regulations of safety; violations as defined by the Human Factors Analysis and Classification System. Contrary to what the accident record seems to suggest, flight into adverse weather may also be influenced by the lack of appreciation/understanding of the hazards associated with adverse weather. Perhaps some encounters with adverse weather were motivated by outside influences or exacerbated by some manner of mechanical failure that may have led to the willful acceptance of unnecessary hazards. Conclusions. These data suggest that current beliefs surrounding flight into adverse weather by GA pilots may be incomplete. The data presented here suggest that additional effort should be placed in training, both ab initio and recurrent. Emphasis should be placed on ensuring a full understanding of the adverse impact of weather, including the recognition of instrument meteorological conditions, icing, convective events, etc. Likewise, with the proliferation of commercial weather products and on-board weather equipment, it may be time to move toward some form of standard weather package that all pilots would review before flying

General Aviation Weather Encounter Case Studies

This study presents a compilation of 24 cases involving general aviation (GA) pilots’ weather encounters over the continental U.S. The project team interviewed pilots who had experienced a weather encounter, and we examined their backgrounds, flight experience, and weather encounter details. Results from meteorological data analysis for each weather encounter were consistent with findings of larger GA weather accident studies in terms of the types of hazards encountered and flight phase during which the encounters occurred. Investigation of pilot weather products and the sources from which they were obtained revealed a lack of uniformity of pre-flight data sources and underutilization of available en route flight information services. The team used these results to develop a set of pilot weather education and training recommendations intended to reduce the number and severity of weather encounters

Fetal Testosterone Predicts Sexually Differentiated Childhood Behavior in Girls and in Boys

ABSTRACT—Mammals, including humans, show sex differences in juvenile play behavior. In rodents and nonhuman primates, these behavioral sex differences result, in part, from sex differences in androgens during early development. Girls exposed to high levels of androgen prenatally, because of the genetic disorder congenital adrenal hyperplasia, show increased male-typical play, suggesting similar hormonal influences on human development, at least in females. Here, we report that fetal testosterone measured from amniotic fluid relates positively to male-typical scores on a standardized questionnaire measure of sextypical play in both boys and girls. These results show, for the first time, a link between fetal testosterone and the development of sex-typical play in children from the general population, and are the first data linking high levels of prenatal testosterone to increased male-typical play behavior in boys. Sexual differentiation of the mammalian brain occurs under the control of gonadal hormones, particularly androgens, during early development (De Vries & Simerly, 2002; Ehrhardt &amp

Calcium supplements and risk of CVD: A meta-analysis of randomized trials

Background: Vitamin D supplements may only be beneficial for the prevention of osteoporotic fractures when administered with calcium and in individuals with low blood levels of 25(OH)D, but possible hazards of calcium supplements on CVD cannot be excluded. Objectives: We conducted a meta-analysis of all placebo-controlled randomized trials assessing the effects of calcium supplements alone or with vitamin D on CHD, stroke, and all-cause mortality. Methods: A meta-analysis of 11 trials included 7 comparisons of calcium alone compared with control (n = 8634) and 6 comparisons of calcium plus vitamin D compared with control (n = 46,804). Aggregated study-level data were obtained from individual trials and combined using a fixed-effects meta-analysis. The main outcomes included MI, CHD death, any CHD, stroke, and all-cause mortality. Results: Among trials of calcium alone (mean daily dose 1 g), calcium was not significantly associated with any excess risk of MI (RR, 1.15; 95% CI: 0.88, 1.51; n = 219 events), CHD death (RR, 1.24; 95% CI: 0.89, 1.73; n = 142), any CHD (RR, 1.01; 95% CI: 0.75, 1.37; n = 177), or stroke (RR, 1.15; 95% CI, 0.90, 1.46, n = 275). Among 6 trials of combined treatment, supplementation with calcium plus vitamin D was not significantly associated with any excess risk of MI (RR, 1.09; 95% CI: 0.95, 1.25; n = 854), CHD death (RR, 1.04; 95% CI: 0.85, 1.27; n = 391), any CHD (RR, 1.05; 95% CI: 0.93, 1.19; n = 1061), or stroke (RR, 1.02; 95% CI: 0.89, 1.17; n = 885). Likewise, calcium alone, or with vitamin D had no significant associations with all-cause mortality. Conclusions: This meta-analysis demonstrated that calcium supplements were not associated with any significant hazard for CHD, stroke, or all-cause mortality and excluded excess risks above 0.3%–0.5% per year for CHD or stroke. Further trials of calcium and vitamin D are required in individuals with low blood levels of 25(OH)D for the prevention of fracture and other disease outcomes

Social cognition in adults with autism spectrum disorders: Validation of the Edinburgh Social Cognition Test (ESCoT).

Objective: Many existing tests of social cognition are not appropriate for clinical use, due to their length, complexity or uncertainty in what they are assessing. The Edinburgh Social Cognition Test (ESCoT) is a new test of social cognition that assesses affective and cognitive Theory of Mind as well as inter- and intrapersonal understanding of social norms using animated interactions.Method: To support the development of the ESCoT as a clinical tool, we derived cut-off scores from a neurotypical population (n = 236) and sought to validate the ESCoT in a sample of Autism Spectrum Disorder (ASD; n = 19) adults and neurotypical controls (NC; n = 38) matched on age and education. The ESCoT was administered alongside established tests and questionnaire measures of ASD, empathy, systemizing traits and intelligence.Results: Performance on the subtests of the ESCoT and ESCoT total scores correlated with performance on traditional tests, demonstrating convergent validity. ASD adults performed poorer on all measures of social cognition. Unlike the ESCoT, performance on the established tests was predicted by verbal comprehension abilities. Using a ROC curve analysis, we showed that the ESCoT was more effective than existing tests at differentiating ASD adults from NC. Furthermore, a total of 42.11% of ASD adults were impaired on the ESCoT compared to 0% of NC adults.Conclusions: Overall these results demonstrate that the ESCoT is a useful test for clinical assessment and can aid in the detection of potential difficulties in ToM and social norm understanding