Broad Perspectives of the Experience of Romantic Relationships and Sexual Education in Neurodivergent Adolescents and Young Adults

Neurodivergent young people tend to struggle with building and maintaining their romantic relationships. Despite this, there appears to be a lack of appropriate sexuality education delivered to them. This review aims to present and discuss the most current literature (conducted between 2015 and current) on romantic relationships and sexuality education in young people with Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and ASD co-occurring with ADHD. Six internet-based bibliographic databases were used for the present review that followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Thirty-one studies were identified in this review. Twenty-six studies investigated the topic in the autistic young population. Four studies explored qualitatively and 11 quantitatively young people’s perspectives of their romantic relationship experiences. One study investigated qualitatively and three quantitatively young people’s perspectives on sexuality education. One study explored qualitatively and five quantitatively young people’s romantic relationship experiences and two explored qualitatively and three quantitatively sexuality education from caregivers’ perspectives. Five studies (all quantitative, self-reports) investigated romantic relationship experiences in the young population with ADHD. The studies conducted on the topic from the educational professionals’ perspectives were absent in the literature. The literature was also non-existent on the topic in the population with ASD co-occurring with ADHD. To the researchers’ knowledge, this is the first review exploring romantic relationships and sexuality education in three groups of neurodivergent young people (with ASD, ADHD, and ASD co-occurring with ADHD)

The development of the Cognitive Behavioural Social Competence Therapeutic Intervention for Adults with Autism: A mixed methods report

Background: Many young people with autism can have an average or above average IQ, yet they still struggle with the social competencies needed to successfully navigate into adulthood. Despite many individuals with autism experiencing significant challenges during their transition into adulthood, evidence‐based therapeutic interventions to support individuals with autism during this transition are limited. The current literature suggests that cognitive behavioural therapy interventions can help improve social skills and the mental health of individuals with autism. However, little is known about the benefits for young adults with autism transitioning or who have transitioned into adulthood. Aims and Method: The aim of this research was to deliver a newly developed Cognitive Behavioural Social Competence Therapeutic Intervention for Adults with Autism (CBSCTI‐A) to five young adults with autism. Research aims were to evaluate intervention feasibility and efficacy by triangulating data findings using a mixed methods approach. Results: Results support feasibility, with CBSCTI‐A receiving very high user satisfaction ratings, and adherence to the intervention was high, recorded at ~90%. Fidelity to treatment was also high, ranging from ~86% to ~100%. Quantitative findings indicate that over an eight‐week time period, a small sample of young adults with autism experienced significant improvements with regard to their social motivation, non‐verbal conversation, emotional empathy, assertiveness, interpersonal relationships and self‐control. Qualitative findings provide further anecdotal support for intervention feasibility and efficacy. After the completion of the intervention, participants and their parents were invited to complete semistructured interviews. Thematic analysis (TA) revealed four main themes: user satisfaction, important components of therapeutic intervention, challenges and critiques, and recommendations. Conclusions: CBSCTI‐A appears to be a feasible intervention; however, future research with larger samples and more rigorous controlled trials is needed before efficacy can be established

Autism spectrum disorder, extremism and risk assessment

Background: To date, there is no evidence supporting the existence of an association between Autism Spectrum Disorder (ASD) and extremism in the general population. However, there is increasing recognition that several features of ASD may provide the context of vulnerability to engage in extremist behaviour. Aims: This paper sets out the case for a dedicated clinical approach to better integrate clinical risk appraisal processes with an assessment of ASD individuals' vulnerabilities within the Criminal Justice System. Methods and Results: In this paper the Framework for the Assessment of Risk & Protection in Offenders on the Autistic Spectrum (FARAS): A Guide for Risk Assessors Working with Offenders on the Autistic Spectrum is explored. In developing the FARAS, Al‐Attar proposed seven facets of ASD that ‘may have different functional links with push and pull factors to terrorism’ (p. 928), which include circumscribed interests; rich vivid fantasy and impaired social imagination; need for order, rules, rituals, routine and predictability; obsessionality, repetition and collecting; social interaction and communication difficulties; cognitive styles and Sensory processing. Discussion and Conclusion: We describe the FARAS within the context of the most widely used clinical risk appraisal ‘aide memoire’ instruments integral to the Structured Professional Judgement of risk process, namely the HCR20v3

Identifying studies examining the validity of instruments for use as outcome measures in child and adolescent forensic mental health services: a systematic review

Background: Outcome measurement in child and adolescent forensic mental health services can support service improvement, research, and patient progress evaluation. This systematic review aimed to identify studies which validate structured instruments available for use as outcome measures in the child and adolescent forensic mental health service cohort and assess the quality of these studies. Methods: A systematic review was conducted following PRISMA guidelines. Studies were identified by searching six online databases in November 2023. The quality and risk of bias of each study meeting inclusion criteria was independently assessed by two authors using the Crowe Critical Appraisal Tool. Results were synthesised narratively. Results: A total of eight studies were identified which met inclusion criteria. These looked at six instruments which primarily focused on outcome measures in the areas of treatment motivation, level of functioning, psychiatric symptoms, care needs and response to social situations. Papers scored between 17/40 and 30/40 on the Crowe Critical Appraisal Tool. Studies were rated as low (n = 1), moderate (n = 6), high (n = 1) or very high quality (n = 0). Conclusions: Despite the large number of structured instruments potentially available, evidence for their use as outcome measures in child and adolescent forensic mental health services is limited. Future research should aim to validate current structured instruments for use in the forensic child and adolescent setting, with consideration of whether new instruments should be developed specifically for this group. Such instruments should be developed with both young people as service users and professionals who will be utilising the instrument in mind

Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case-control study

Abstract Background: To investigate whether later diagnosis of psychiatric disorder can be predicted from analysis of mother-infant joint attention (JA) behaviours in social-communicative interaction at 12 months. Method: Using data from a large contemporary birth cohort, we examined 159 videos of a mother-infant interaction for joint attention behaviour when children were aged one year, sampled from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Fifty-three of the videos involved infants who were later considered to have a psychiatric disorder at seven years and 106 were same aged controls. Psychopathologies included in the case group were disruptive behaviour disorders, oppositional-conduct disorder, attentiondeficit/hyperactivity disorder, pervasive development disorder, anxiety and depressive disorders. Psychiatric diagnoses were obtained using the Development and Wellbeing Assessment when the children were seven years old

A realist evaluation of an enhanced court‐based liaison and diversion service for defendants with neurodevelopmental disorders

Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs

Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case–control study

<br>Background: To investigate whether later diagnosis of psychiatric disorder can be predicted from analysis of mother-infant joint attention (JA) behaviours in social-communicative interaction at 12 months.</br> <br>Method: Using data from a large contemporary birth cohort, we examined 159 videos of a mother-infant interaction for joint attention behaviour when children were aged one year, sampled from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Fifty-three of the videos involved infants who were later considered to have a psychiatric disorder at seven years and 106 were same aged controls. Psychopathologies included in the case group were disruptive behaviour disorders, oppositional-conduct disorder, attention-deficit/hyperactivity disorder, pervasive development disorder, anxiety and depressive disorders. Psychiatric diagnoses were obtained using the Development and Wellbeing Assessment when the children were seven years old.</br> <br>Results: None of the three JA behaviours (shared look rate, shared attention rate and shared attention intensity) showed a significant association with the primary outcome of case–control status. Only shared look rate predicted any of the exploratory sub-diagnosis outcomes and was found to be positively associated with later oppositional-conduct disorders (OR [95% CI]: 1.5 [1.0, 2.3]; p = 0.041).</br><br>Conclusions: JA behaviours did not, in general, predict later psychopathology. However, shared look was positively associated with later oppositional-conduct disorders. This suggests that some features of JA may be early markers of later psychopathology. Further investigation will be required to determine whether any JA behaviours can be used to screen for families in need of intervention.</br&gt

A legal analysis of Australian criminal cases involving defendants with autism spectrum disorder charged with online sexual offending

This paper examines how the symptomology of the small number of individuals with autism spectrum disorder (ASD) charged with online sexual offenses in Australia is established during legal arguments and conceived by the judiciary to impact legal liability and offending behavior. This study aims to provide empirical support for the proposition that judicial discourses regarding the connection between ASD and online sexual offending, including conduct related to child exploitation material (CEM), have little bearing on overall questions of criminal liability or the use of alternative penal dispositions. It does so by exploring a sample of nine recent Australian criminal cases, involving ten rulings, that examine how evidence of ASD is raised in legal arguments in ways that suggest a diagnosed condition may have contributed significantly to the alleged wrongdoing. We conclude by suggesting current Australian judicial practice requires more sensitivity to the impact of clinical factors associated with ASD in shaping alternative supervisory and non-custodial dispositions for individuals convicted of online sexual offenses. Previous article in issu