Fred R. Volkmar

Seventy years have passed since Leo Kanner’s classic description of autism. Although the pace of research has increased dramatically, research specifically focused on adolescents and adults remains limited in many respects. Numerous outcome studies have been conducted and suggest potential for markedly improved outcome with intervention. Unfortunately studies on adults after early adulthood are sparse indeed. This volume reviews work in multiple areas. The chapters review what is known and highlight important areas for future research. It does appear that with support more and more individuals with autism/autism spectrum disorder can be independent and self-sufficient. New models of care are needed to support these individuals as well as those who continue to need high levels of care.

Provision of medical care to adults with autism has been complicated for a host of reasons. These include issues of lack of research data, insufficient guidance on best practices and information on approaches to the person with ASD, problems with insurance, and others. The limited data available suggest potential increased risk for certain medical and mental health problems. Clearly, costs for good medical care are increased even at a time when insurance reimbursement is limited and education for individuals with ASD on getting quality care has been minimal.As a result of these problems, medical care is often delivered in emergency department settings, and the absence of primary care providers can mean that conditions are overlooked at a time when they are most treatable. Available data suggest increased rates of morbidity in the ASD population. In this chapter, we outline some of the current obstacles and …

As individuals with autism become older, they are at increased risk for various mental health conditions. Rates of anxiety and depression appear to be the most clearly increased (although rates vary depending on samples and methods used). Suicidal thinking and sometimes suicidal actions are also increased. Other noteworthy problems include issues of gender identity and substance abuse. Sadly, the data on middle-aged and older adults are generally lacking.Interpretation of available data is complex. Often results of treatment studies are too readily generalized from one age group to another. Studies of mental health issues in adults with ASD repeatedly comment on the need for better and more precise instruments. Working with individuals who have multiple needs is particularly challenging – especially when solid evidence-based treatment guidelines are lacking. Issues of treatment choice and cost …

Although first described in 1944 (the year the description of infantile autism), Asperger’s syndrome attracted little attention until the publication by Lorna Wing in early 1980. Over time, different views of the definition of Asperger’s syndrome developed. By the time of the Third Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual and the Tenth Edition of the World Health Organization’s International Classification of Disease, enough information had accumulated to include the condition within the broader autism category. Asperger’s syndrome remained a focus of research interest and debate until its exclusion in the DSM-5 in 2013. We argue that the decision to remove Asperger’s syndrome 10 years ago as a distinct condition was premature. A discussion of the tensions around defining Asperger’s and concerns now arising due to the lack of this diagnostic category for new cases is provided.

Difficulty with attention is an important symptom in many conditions in psychiatry, including neurodiverse conditions such as autism. There is a need to better understand the neurobiological correlates of attention and leverage these findings in healthcare settings. Nevertheless, it remains unclear if it is possible to build dimensional predictive models of attentional state in a sample that includes participants with neurodiverse conditions. Here, we use 5 datasets to identify and validate functional connectome-based markers of attention. In dataset 1, we use connectome-based predictive modeling and observe successful prediction of performance on an in-scan sustained attention task in a sample of youth, including participants with a neurodiverse condition. The predictions are not driven by confounds, such as head motion. In dataset 2, we find that the attention network model defined in dataset 1 generalizes to …

Michael Rutter, a giant in the field of autism research, child psychiatry, and child mental health, died at his home in London on October 23, 2021 at 88 years of age. Educated at the University of Birmingham and London, Mike was affiliated with the Maudsley Hospital and the Institute of Psychiatry throughout his professional career. In the middle of a career that spanned almost 60 years, Michael Rutter received one of many honors over his lifetime in 1985. This was an Honorary Doctorate from the University of Leiden, following in the footsteps of other luminaries like Albert Bandura, Carl Rogers and Nelson Mandela. However, what pleased Mike most about the award was that, when he was introduced, the master of ceremonies commented that since Mike was born in Beirut, had a Welsh middle name, was a teenager in the US, and loved the Lake District, he must be Dutch! One of the gifts that Michael Rutter gave …

The purpose of this article is to explore the intersectionality of autism and sociocultural factors as well as discuss the complexities associated with appropriate assessment, diagnosis, and intervention. Based on a review of the literature, the authors present a brief history of the emergence of the term autism and highlight factors that have contributed to current concerns about failures to appropriately recognize autism within diverse populations. Referencing extant research as well as professional practice standards, this article examines aspects of autism and intersectionality, and explores some of the associated challenges related to assessment, diagnosis, and intervention. Further, the authors reflect on the critical importance of carefully considering all aspects of a child's identity when engaging in autism assessment and intervention within the school setting. School‐based practitioners are provided with guidance for …

The transition to adulthood presents challenges for all adolescents. For students with disabilities, these challenges are often much greater. This chapter reviews these challenges and potential supports, focusing specifically on youth with autism spectrum disorder (ASD). Youth with ASD do, of course, face all the usual challenges of adolescence in terms of bodily changes, sexual feelings, issues of planning for adulthood, academic and vocational planning, separation from parents, and so on. However, increased complexities of this period for youth with ASD present special issues for transition planning. Challenges for provision of both medical and mental health issues arise from the nature of autism and are only compounded by a fragmented care system. Bullying can be a problem for all adolescents but is a particular concern for those with special needs. The growing number of individuals who are able to marry …