Autism Champion Blog 2022

It’s now over a year since I became the College autism champion and it seems to have gone by in a flash. One of the most heartening developments over that time is how autism and neurodivergence are starting to rise up the College’s agenda. Neurodevelopmental conditions feature prominently in the new psychiatric training curricula.

The British Journal of Psychiatry just published a powerful editorial by Sue McCowan et al about the experience of autistic psychiatrists. And the latest edition of the College Insight magazine features a front cover article about neurodiversity, including interviews with me and neurodivergent psychiatrist Dr Tahleel Javid.

Of course, giving more prominence to autism and neurodivergence is just the first step. As a profession, all psychiatrists need to appreciate the greatly elevated risk of mental health problems in autism. As expert communicators, we need to make reasonable adjustments to psychiatric treatments for autistic patients with mental health needs. And as a college, we need to make sure that our autistic and neurodivergent members feel understood and supported throughout their training and their careers.

One aspect of effective communication is the language we use. I recently had a meeting with Dr Laura Coulthard and Emma Rogan, who work with autistic young people in County Durham. Laura and Emma have conducted research into preferred autism terminology, 573 participants with lived experience of autism (autistic people, carers and clinicians) took part.

Their findings show an overwhelming majority of autistic people prefer the term autism and autistic to the terms autistic spectrum disorder or ASD. My arguments that ‘the DSM-V and ICD-11 call it autistic spectrum disorder so we have to as well’ felt pretty weak in comparison to Laura and Emma’s impassioned plea for the service user voice to be put first. In fact, I was so impressed that I have invited Laura and Emma to come to a meeting of the Royal College Autism Group and make their case.

Speaking of the Autism Group, we are looking for two new trainee representatives – one for the Autism Group, and one for the Neurodevelopmental Special Interest Group. If you are a psychiatry trainee with an interest in autism and neurodevelopmental conditions, and you would like to get involved with our work, please get in touch by emailing me: conor.davidson@nhs.net.

Finally, I want to mention an exciting research project my team has recently got involved with. It is called STRATA (SerTRaline for AnxieTy in adults with a diagnosis of autism). STRATA is a randomised controlled trial looking whether sertraline is better than placebo for treatment of anxiety in autistic adults. A few autistic people have asked me why we would be using psychiatric medication in autism at all.

However, it is important to stress that STRATA is not about treating autism itself; it is about treating anxiety that co-occurs with autism. Anxiety is the most common mental health problem affecting autistic people, but we have a dearth of high-quality research about the role of medications in its treatment which are very frequently prescribed. STRATA is aiming to fill some of this evidence gap. It is the first ever large scale RCT in the field and has been co-designed from top-to-bottom with autistic people. Please visit the STRATA website for more information on how to take part or refer someone to this study.