Diagnosing autism spectrum disorders in elderly people.
BACKGROUND
As autism spectrum disorders (ASD) have largely been neglected in old-age psychiatry, the objective of the present paper is to describe the diagnostic process in elderly patients.


METHODS
A systematic review of the literature on ASD in older age was undertaken and illustrated by a case series of three elderly patients first diagnosed with ASD in later life by a tertiary mental health clinic.


RESULTS
The search of the literature only yielded three papers on late-life ASD, while the review of the available diagnostic procedures among adults suggests some relevance for screening instruments (Autism Questionnaire), diagnostic instruments (Module 4, Autism Diagnostic Observation Schedule), and neuropsychological examination to profile impairments. Nonetheless, the case reports clearly showed that taking a thorough history with the patient, corroborated and supplemented by a close relative or caregiver who has known the patient for at least ten years, still remains the most important diagnostic tool.


CONCLUSIONS
The three case studies show that in clinical practice ASD can easily be missed in elderly individuals presenting with comorbid psychiatric disorders, potentially causing iatrogenic damage. Although further research on phenotyping and diagnosing ASD in older people is warranted, the most important step at this point is to create a greater awareness of the possibility of ASD in old age among health-care professionals working with people in this age group.
Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
Maarten E H
ME
van Niekerk
Wouter
W
Groen
Constance Th W M
CT
Vissers
Dorine
D
van Driel-de Jong
Cees C
CC
Kan
Richard C
RC
Oude Voshaar
D000368:Aged; D000369:Aged, 80 and over; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D060685:Sense of Coherence; D056345:Theory of Mind