Specialistisch centrum ontwikkelingsstoornissen

BACKGROUND:
Individuals with autism spectrum disorder (ASD) are at risk to develop more pervasive emotion-dysregulation and as a consequence maladaptive coping as compared to non-autistic people (Conner et al., 2020; Maddox, Trubanova & White, 2017). Sensory differences and impaired interoceptive body-awareness may influence emotion-dysregulation. Maladaptive coping is reflected by a variety of harmful behaviours, particularly strong social avoidance, obsessive-compulsive symptoms, disordered eating, substance abuse, agitation, non-suicidal-self-injury (NSSI), and suicidal ideation and behaviour. For a part of these individuals, treatment as usual does not have any effect at all, causing a vicious circle of isolation, demoralization, life-long psychiatric treatments, and crisis.
As of yet, there is no empirically tested conceptual framework for the continued existence and treatment of severe emotion-dysregulation in individuals with autism. As a consequence, research into treatment of adults with severe emotion-dysregulation is scarce, and it remains unknown which are the potential factors and mechanisms that predict, advance, and hinder the pathway to recovery.
Dialectical Behaviour Therapy (DBT) is an empirically supported psychotherapy to treat emotion-dysregulation, particularly in individuals with borderline personality disorder (Linehan, 1993). An effective inpatient treatment for adults with ASD and severe emotion-dysregulation is lacking, as well insight in the development of the process of self-regulation, particularly the role of sensory hyper- and hyposensitivity and interoceptive body-awareness. Therefore, an integrated, mostly inpatient treatment program based on DBT is developed and outcomes will be evaluated in the currently presented research. Standard DBT is used, adapted to adults with ASD, and augmented with a body-oriented DBT- skills training, because of their possible impairments of interoceptive body-awareness. Experiences of participants with the treatment program, the mechanisms and processes that hinder and advance the pathway to recovery will be studied, in order to make the treatment more tailored and effective for this target group.

Sensory processing difficulties can be associated with a wide range of symptomatology (Ben-Avi, Almagor & Engel-Yeger, 2012), for example aggressive behaviors. Especially within the Autism Spectrum Disorder (ASD) sensory processing difficulties and aggressive behaviors are strongly associated (Boogert et al., 2020, in prep.). Both ASD and aggressive behaviors are overrepresented in forensic mental health care institutions (Bosch, Chakhssi & Hummelen, 2020; Dickens, Picchioni & Long, 2013). Focus of the present qualitative case series is the perceived value of sensory processing diagnostics in therapies with treatment goals concerning aggressive behaviors especially inside the forensic mental healthcare sector. Therefore, a semi structured interview will be conducted with 4 therapists and each one of their patients who all report different combinations of the ASD diagnosis, sensory processing difficulties and treatment within a forensic institution. The sensory processing profile of the patients will be quantified with the Adolescent/Adult Sensory Profile (AASP; Brown & Dunn, 2002). With the Aggression - Questionnaire Short Form (AQ-SF; Bryant & Smith, 2001) and the Reactive Proactive Aggression Questionnaire (RPQ; Raine et al., 2006) we will examine the patients’ aggression. We expect that the inclusion of the sensory profiles will be perceived by both patients and therapists as valuable and helpful for the achievement of the treatment goals in the therapies.

Doel onderzoek:
Dit onderzoeksproject stelt zicht ten doel om de mogelijke associatie tussen problemen in de prikkelverwerking en agressieproblematiek in normaal- tot hoogbegaafde patiënten met een autismespectrumstoornis vast te stellen, te typeren en te relateren aan het niveau van autistisch gedrag.

Centrale vraagstelling:
In hoeverre is het sensorisch profiel geassocieerd met gerapporteerd agressief gedrag bij normaal- tot hoogbegaafde volwassenen met een autismespectrumstoornis? Hoe is deze associatie te typeren en in hoeverre is het niveau van gerapporteerd autistisch gedrag van invloed op deze associatie?

Aanleiding:  
Recent onderzoek toont aan dat er bij autismespectrumstoornissen (ASS) en bij ADHD veel comorbiditeit voorkomt, vooral angst en depressieklachten. Deze kunnen het functioneren  ernstig belemmeren (uitval op het werk, relatieproblemen, etc.). Angst en depressie wordt erger als er ook sprake is van een lage zelfwaardering (self-esteem). Omgekeerd, heeft verbetering van zelfwaardering een gunstig effect op angst en depressie. Zelfwaardering kan op een effectieve manier worden versterkt door middel van Competitive Memory Training (COMET).
Wij verwachten dat COMET therapie bij volwassenen met ontwikkelingsstoornissen als ASS en ADHD niet alleen de zelfwaardering kan verbeteren, maar ook kan bijdragen aan een afname van de angst en depressieklachten.