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      Autistic spectrum disorders, personality disorder and offending in a transgender patient: clinical considerations, diagnostic challenges and treatment responses

      Advances in Autism
      Emerald Group Publishing Limited
      Complex needs, Offending behaviour, Services, Adults, Autism spectrum disorder, Mental disorder

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          Abstract

          Purpose – The case of a woman with a history of offending and prolonged imprisonment is given. The purpose of this paper is to explore the complex interplay between diagnoses of autistic spectrum disorder (ASD), personality disorder and gender dysphoria. A discussion on useful and less useful treatment approaches follows, given the unusual and complex clinical presentation. Design/methodology/approach – This is a case report with a summary of the background to this under-researched area. Findings – The way in which the diagnostic picture clarified over time is explained. The difficulties in accurately diagnosing are put forward and strategies to address this are suggested. Successful treatment of unusual clinical problems may require highly individualised care within generic services. Originality/value – The authors know of no similar case reports in the published literature. The clinical associations between ASDs, personality disorders and gender dysphoria, in forensic mental health populations, appears to be unexplored in the literature.

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          Most cited references8

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          Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

          Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.
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            Prevalence of Asperger's syndrome in a secure hospital.

            The hypothesis that Asperger's syndrome (AS) may go unrecognised in forensic populations was examined by ascertaining the prevalence in Broadmoor Special Hospital. The entire male patient population was screened by examination of case notes. Identified cases were subject to the next stage of the study, which involved observation and interviewing of patients, and a semi-structured interview of key staff. A prevalence of 1.5% (0.6% to 3.3%, 95% CI) was found. The addition of equivocal cases increased the prevalence to 2.3%. The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population.
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              The Adult Asperger Assessment (AAA): a diagnostic method.

              At the present time there are a large number of adults who have suspected Asperger syndrome (AS). In this paper we describe a new instrument, the Adult Asperger Assessment (AAA), developed in our clinic for adults with AS. The need for a new instrument relevant to the diagnosis of AS in adulthood arises because existing instruments are designed for use with children. Properties of the AAA include (1) being electronic, data-based, and computer-scorable; (2) linking with two screening instruments [the Autism Spectrum Quotient (AQ) and the Empathy Quotient (EQ)]; and (3) employing a more stringent set of diagnostic criteria than DSM-IV, in order to avoid false positives. The AAA is described, and its use with a series of n = 42 clinic-patients is reported. Thirty-seven of these (88%) met DSM-IV criteria, but only 34 of these (80%) met AAA criteria. The AAA is therefore more conservative than DSM-IV.
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                Author and article information

                Journal
                10.1108/AIA-10-2015-0019

                Psychology
                Complex needs,Offending behaviour,Services,Adults,Autism spectrum disorder,Mental disorder
                Psychology
                Complex needs, Offending behaviour, Services, Adults, Autism spectrum disorder, Mental disorder

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