Identification of autism in cognitively able adults with epilepsy: A narrative review and discussion of available screening and diagnostic tools.

This review found that there's very little research on identifying autism in adults with epilepsy who have typical thinking abilities. New epilepsy guidelines say doctors should look for autism signs, but we don't have good screening tools tested specifically for people with epilepsy. Only two autism questionnaires have been used for this group, and we need more research to understand how autism appears in people with epilepsy.

This narrative review examines the identification of autism in cognitively able adults with epilepsy, highlighting a significant gap in current research. The 2022 NICE epilepsy guidelines recommend that epilepsy professionals screen for autism when considering mental health and behavioral presentations. However, few studies have investigated autism in cognitively able people with epilepsy. The review describes available screening tools, noting that only two (AQ and SRS-AS) have been specifically used for this population, with AQ showing better psychometric properties.

The authors identify potential overlap between autism screening questions and psychiatric disorder symptoms, and call for validation studies of gold-standard diagnostic tools in this specific population.

Clinicians working with epilepsy patients need awareness of autism presentations but currently lack validated screening tools. The AQ may be the best available option, though caution is needed regarding overlap with psychiatric symptoms. Formal validation studies are urgently needed for this population.

This is a narrative review rather than systematic review, limiting the comprehensiveness and reproducibility of findings. The authors acknowledge the scarcity of existing research, which limits the evidence base for recommendations.

The recent NICE epilepsy Guideline (NG217; 2022) recommends that epilepsy professionals need to be alert to autism when considering mental health presentations, behavioural difficulties and as a marker for referral for whole genome sequencing for those patients with epilepsy of unknown cause. However, this relies upon the existence of valid autism screens for people with epilepsy (PWE). We found few studies of autism in cognitively able PWE. This represents an important gap in the literature.

We describe different autism screening and diagnostic tools; two screening tools have been used specifically for adult PWE who are cognitively able (AQ, SRS-AS). The AQ is more psychometrically robust, but there may be an overlap between these screening questions and questions relevant to some psychiatric disorders. Formal gold-standard diagnostic tools (module 4 of ADOS-2, ADI-R or 3Di or 3Di-Adult) would benefit from studies of their application to cognitively able PWE. More research is needed to understand the characteristics of autism in cognitively able PWE and to ascertain the appropriate screening and diagnostic tools for this cohort.