The face validity of an initial sub-typology of people with autism spectrum disorders detained in psychiatric hospitals.
Magali Barnoux, Regi Alexander, Sabyasachi Bhaumik and 8 others
PMID 32564628WHAT IT FOUND
Clinicians and service users agreed this typology for autism in secure hospitals makes sense but is too complex for patients.
Psychosis and psychopathy were seen as key drivers of risk, while behavioural problems were often viewed as secondary to these conditions.
Key findings
01Participants agreed the typology's purpose was to differentiate subgroups based on risk severity, though they suggested prioritising psychosis, then psychopathy, then behavioural problems in clinical diagrams.
02Service users and family carers reported struggling to understand the typology due to its complexity and reliance on diagnostic labels.
03Clinicians found assigning cases to the psychopathy and behavioural problem categories difficult, often requiring more historical information to make accurate distinctions.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relies on a very small number of participants (7 in the focus group, 5 per rating round), limiting how widely these views apply. The consensus rating used written case vignettes rather than real-time patient assessments, which may not reflect the complexity of actual clinical decision-making. The typology has not yet been tested quantitatively in a large clinical sample to prove it predicts outcomes or risk accurately. Service users and family members reported the typology was too complex for them to understand, raising concerns about its practical utility in person-centred care without simplification.
Declared interests
The authors declared no conflicts of interest. The research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme.
The easy way to misread this
Do not assume this typology is a validated diagnostic tool for clinical use. The study only assessed whether experts thought it made sense (face validity) and whether they could apply it to written cases. The authors explicitly state that robust quantitative evaluation is still needed before recommending its use in practice.