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      The Vulnerability Experiences Quotient (VEQ): A Study of Vulnerability, Mental Health and Life Satisfaction in Autistic Adults

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          Abstract

          Co‐morbid mental health conditions such as anxiety and depression are extremely common in autistic adults. Vulnerability to negative life experiences such as victimisation and unemployment may be partially responsible for the development of these conditions. Here we measure the frequency of negative life experiences in autistic adults and explore how these are associated with current anxiety and depression symptoms and life satisfaction. We developed the Vulnerability Experiences Quotient (VEQ) through stakeholder consultation. The VEQ includes 60 items across 10 domains. Autistic adults with a clinical diagnosis and non‐autistic controls completed the VEQ, screening measures for anxiety and depression, and a life‐satisfaction scale in an online survey. Likelihood of experiencing each VEQ event was compared between groups, using binary logistic regression. Mediation analysis was used to test whether total VEQ score mediated the relationship between autism and (1) depression (2) anxiety and (3) life satisfaction. Autistic adults ( N = 426) reported higher rates of the majority of events in the VEQ than non‐autistic adults (N = 268). They also reported more anxiety and depression symptoms and lower life satisfaction. Group differences in anxiety, depression and life satisfaction were partially mediated by VEQ total score. This study highlights several important understudied areas of vulnerability for autistic adults, including domestic abuse, contact with social services (as parents) and financial exploitation and hardship. Improved support, advice and advocacy services are needed to reduce the vulnerability of autistic adults to negative life experiences, which may in turn improve mental health and life satisfaction in this population. Autism Res 2019, 12: 1516–1528 . © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.

          Lay Summary

          This study investigated whether autistic adults are more vulnerable to certain negative life experiences, and whether these experiences are related to anxiety, depression and life satisfaction. We found that autistic adults are more vulnerable to many different negative life events, including employment difficulties, financial hardship and domestic abuse. Negative life experiences partially explained the higher rates of anxiety and depression symptoms and lower life satisfaction in autistic adults compared to non‐autistic adults. Improved support services are required to reduce the vulnerability of autistic adults. Reducing vulnerability may improve mental health and increase life satisfaction in this population.

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          Toward brief “Red Flags” for autism screening: The Short Autism Spectrum Quotient and the Short Quantitative Checklist for Autism in toddlers in 1,000 cases and 3,000 controls [corrected].

          Frontline health professionals need a "red flag" tool to aid their decision making about whether to make a referral for a full diagnostic assessment for an autism spectrum condition (ASC) in children and adults. The aim was to identify 10 items on the Autism Spectrum Quotient (AQ) (Adult, Adolescent, and Child versions) and on the Quantitative Checklist for Autism in Toddlers (Q-CHAT) with good test accuracy. A case sample of more than 1,000 individuals with ASC (449 adults, 162 adolescents, 432 children and 126 toddlers) and a control sample of 3,000 controls (838 adults, 475 adolescents, 940 children, and 754 toddlers) with no ASC diagnosis participated. Case participants were recruited from the Autism Research Centre's database of volunteers. The control samples were recruited through a variety of sources. Participants completed full-length versions of the measures. The 10 best items were selected on each instrument to produce short versions. At a cut-point of 6 on the AQ-10 adult, sensitivity was 0.88, specificity was 0.91, and positive predictive value (PPV) was 0.85. At a cut-point of 6 on the AQ-10 adolescent, sensitivity was 0.93, specificity was 0.95, and PPV was 0.86. At a cut-point of 6 on the AQ-10 child, sensitivity was 0.95, specificity was 0.97, and PPV was 0.94. At a cut-point of 3 on the Q-CHAT-10, sensitivity was 0.91, specificity was 0.89, and PPV was 0.58. Internal consistency was >0.85 on all measures. The short measures have potential to aid referral decision making for specialist assessment and should be further evaluated.
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            Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation.

            The authors evaluated emotional distress among 9th-12th grade students, and examined whether the association between being lesbian, gay, bisexual, and/or transgendered (i.e., "LGBT") and emotional distress was mediated by perceptions of having been treated badly or discriminated against because others thought they were gay or lesbian. Data come from a school-based survey in Boston, Massachusetts (n = 1,032); 10% were LGBT, 58% were female, and ages ranged from 13 to 19 years. About 45% were Black, 31% were Hispanic, and 14% were White. LGBT youth scored significantly higher on the scale of depressive symptomatology. They were also more likely than heterosexual, non-transgendered youth to report suicidal ideation (30% vs. 6%, p < 0.0001) and self-harm (21% vs. 6%, p < 0.0001). Mediation analyses showed that perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males. Perceived discrimination is a likely contributor to emotional distress among LGBT youth.
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              Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis.

              To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood. A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I(2) test. Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse.The combined ORs for anxiety were 2.52 (95 % CI:2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18)for physical abuse. High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.
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                Author and article information

                Contributors
                slg68@medschl.cam.ac.uk
                Journal
                Autism Res
                Autism Res
                10.1002/(ISSN)1939-3806
                AUR
                Autism Research
                John Wiley & Sons, Inc. (Hoboken, USA )
                1939-3792
                1939-3806
                05 July 2019
                October 2019
                : 12
                : 10 ( doiID: 10.1002/aur.v12.10 )
                : 1516-1528
                Affiliations
                [ 1 ] Autism Research Centre, Department of Psychiatry University of Cambridge Cambridge United Kingdom
                [ 2 ] CLASS Clinic Cambridgeshire and Peterborough Mental Health NHS Foundation Trust (CPFT) Cambridge United Kingdom
                Author notes
                [*] [* ]Address for correspondence and reprints: Sarah Griffiths, Autism Research Centre, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK; E‐mail: slg68@ 123456medschl.cam.ac.uk
                Author information
                https://orcid.org/0000-0002-0720-4511
                Article
                AUR2162
                10.1002/aur.2162
                6851759
                31274233
                d969fc76-87c9-438c-a98e-6c487da0782d
                © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 September 2018
                : 03 March 2019
                : 27 May 2019
                Page count
                Figures: 1, Tables: 5, Pages: 13, Words: 10349
                Funding
                Funded by: Innovative Medicines Initiative 2 Joint Undertaking , open-funder-registry 10.13039/501100010767;
                Award ID: 777394
                Funded by: Peterborough NHS Foundation Trust
                Funded by: Care East of England
                Funded by: National Institute for Health Research (NIHR) , open-funder-registry 10.13039/501100000272;
                Funded by: Collaboration for Leadership in Applied Health Research
                Funded by: Queen Anne's Gate Foundation
                Funded by: Autism Research Trust and Autistica
                Award ID: 7238
                Categories
                Research Article
                Research Articles
                Psychology
                Custom metadata
                2.0
                October 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.1 mode:remove_FC converted:13.11.2019

                vulnerability,mental health,life satisfaction,depression,anxiety,adulthood,victimisation

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