Abstract
Critical Literature Review:Significant topographical overlap between OCD and autism-related restricted, repetitive behaviours (RRB) may impact how we understand their co-occurrence. There is a dearth in understanding how research has begun exploring the overlap of these phenomena. This systematic scoping review aimed to summarise the methodology, designs and quality of the literature assessing both OCD and RRB in autism populations.
Searches were conducted across PubMed, Embase, Web of Science and Psych-Info databases. Screening and data charting was completed using Covidence. Quality analysis was assessed using the MMAT.
Eleven of the fourteen studies included for full-text review collected quantitative data only. Structured clinical observations were the most common method used to assess RRB and OCD symptoms. Self-report methods were less common for RRB than OCD assessment. The quality of the included studies was fair, with lower ratings for studies with confounding variables.
Recommendations include research considering bottom-up approaches, such as qualitative methods and developing self-report methods to better understand the co-occurrence of OCD and RRB with autistic clients.
Service-Related Project:
Background: The Rowland Universal Dementia Assessment Scale (RUDAS) has been noted by national dementia guidelines and emerging evidence to have higher validity and reliability than gold standard dementia screening tools with minority client groups. Guidelines also state clear recommendations for translator use for memory services.
Objective: This audit aimed to investigate how often the RUDAS is used, with which appropriate client groups and how translators were mobilised within a memory assessment service within Gloucestershire.
Method: Consecutive clients accessing the memory service in 2019 for a dementia screening assessment were reviewed for eligibility: non-White British ethnicity and/or English not stated as preferred language and/or diagnosis of a learning disability (N=78). Using a systematic pre-developed audit tool, data was collected from clients’ electronic patient records.
Results: Professionals used the RUDAS with 14.2% of eligible clients. Qualitative information from professionals supported that the ACE-III was unsuitable. Translators were infrequently used for those with English as their second language (27%).
Recommendations: Recommendations from stakeholders were provided to the service, including:
• Further investigation to understand barriers and good practice of practitioners completing the screening,
• Co-produced training on how to use the RUDAS should be provided to both translators and practitioners and,
• Clear documentation processes are suggested to prevent missing data and record practitioner decision making around screening tool choice.
Main Research Project:
Obsessive-compulsive disorder (OCD) commonly co-occurs with autism. Research characterising the interplay between restricted, repetitive behaviours related to autism (RRB) and OCD symptoms has used theory-driven, bottom-up methodology. This study aimed to interview autistic adults about their subjective experiences of differentiating between these phenomena.
Semi-structured interviews were conducted with fifteen autistic adults experiencing OCD symptoms and RRB. Transcripts were analysed using reflexive thematic analysis from a critical-realist, inductively orientated stance.
Three overarching themes are presented. Participants viewed RRBs as intrinsic to their identity, while OCD remained ego-dystonic and a perpetuator of anxiety. Conversely, RRBs were present across various emotions, serving as a method to manage anxiety. Routinised behaviours and special interests were considered by participants to be vulnerable to OCD exploitation. Although participants reported masking both RRB and OCD symptoms, the methods and motivations to mask differed.
This research demonstrates the importance of delineating these phenomena, with suggestions offered in how to explore this with autistic clients. Future research could explore narratives of masking OCD across neurotypical and neurodiverse communities and investigate simultaneous co-occurrence of OCD and RRB; including how special interests may influence OCD and how repetitive routines may be intensified by OCD.
| Date of Award | 22 Sept 2023 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Ailsa Russell (Supervisor) & Kate Cooper (Supervisor) |
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