Understanding the autism assessment experience for young people

McQuilton, Philippa (2023). Understanding the autism assessment experience for young people. University of Birmingham. Clin.Psy.D.

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Abstract

Purpose: Government reports highlight global statistics of the number of autistic people admitted to psychiatric inpatient settings, however it is not clear the types of settings included in these reports, or the rate compared to non-autistic people. Literature reporting on autism demonstrates high rates of co-occurring mental health difficulties for autistic people, including more severe and life-threatening incidents often leading to inpatient admissions. National guidance suggests autistic people should be offered specialist care and treatment however, it is often reported this population are admitted to unsuitable, generic settings. This meta-analysis aims to synthesise the empirical literature reporting prevalence of autistic people in generic inpatient settings, with the aim to emphasise the over-representation.

Method: A systematic search of three databases (Ovid PsycInfo, Ovid Embase and Ovid Medline) was conducted on 25th July 2022. Specific search criteria were used to identify papers reporting on autistic people and psychiatric inpatient settings. Returned studies were reviewed using established inclusion and exclusion criteria. Data from the included studies were extracted and analysed. A quality assessment including risk of bias and design hierarchy were undertaken and subgroup analyses were performed.

Results: Fifteen studies were included in the review and rated in terms of methodological quality. The meta-analysis estimated the prevalence of autistic people in psychiatric inpatient settings to be 11%, with a 95% confidence interval of 6-16% (13% for child inpatient settings and 4% for adult inpatient settings). The prevalence rate found by the review is much higher than the prevalence of autistic people in the general population. Significantly higher prevalence was estimated for studies of children vs. adults. High levels of heterogeneity were explored statistically.

Discussion: This review indicates that autistic people are over-represented in psychiatric inpatient settings. Differences in recruitment of autistic people, detection of autism, the settings themselves and referral pathways for autistic patients to inpatient settings may play a role in the prevalence rates found. Furthermore, the level of reporting bias was found to be significant where unclear reporting of prevalence figures suggested smaller event rates and may have missed the full autistic population in their calculations.

Type of Work:

Thesis (Doctorates > Clin.Psy.D.)

Award Type:

Doctorates > Clin.Psy.D.

Supervisor(s):