Rates of Autism in a Population of Homeless Adults

Background:

It is well documented that people with autism spectrum condition (ASC, also known as ‘autism spectrum disorder’) are at high risk of having a number of problems adapting to adult life, such that they experience high rates of unemployment, social isolation and difficulties living independently. In the general population, these types of problem are risk factors for becoming homeless. This raises the question of whether autistic adults experience elevated levels of homelessness. To date there has been no peer-reviewed research into whether or not ASC is associated with an increased risk of homelessness.

Objectives:

This study aimed to investigate systematically the rates of ASC in a long-term homeless population; and to increase understanding of the characteristics and needs of autistic homeless people.

Methods:

The entire caseload of a UK homeless outreach team was screened (n = 106). A new assessment tool, the ‘DSM-5 Autistic Traits in Homeless Individuals’ (DATHI) interview, was developed specifically for this study. This used reports from keyworkers to identify diagnostic features of ASC in their clients. The inter-rater reliability and criterion validity of the DATHI were evaluated.

Results:

The DATHI showed adequate inter-rater reliability (Kappa=.69). Criterion validity, assessed via agreement with the Autism Spectrum Disorder Adult Screening Questionnaire, was strong (r=.81, p=.01). The DATHI identified 13 individuals who showed strong evidence of meeting diagnostic criteria for ASC, which as a proportion of the overall sample was 12.3%, 95% CI [7.0%, 20.4%]. Compared to non-autistic homeless people, those with autistic difficulties showed higher odds of becoming homeless due to being unable to live independently (OR: 3.48, 95% CI [1.03,11.79]). Once homeless, they showed increased odds of consistently declining offers of statutory accommodation (OR: 2.79, 95% CI [1.04,7.48]) and of being socially isolated (OR = 4.62, 95% CI [3.66, 33.35]). Based on keyworker report, those with elevated autistic traits showed reduced odds of currently using drugs or alcohol (OR = 2.92, 95% CI [1.07, 7.98]).

Conclusions:

This study has provided initial evidence that rates of ASC are raised among homeless people, suggesting that ASC is a major risk factor for homelessness. Further, participants with autistic symptoms appeared to be a distinct subpopulation, with autism-specific pathways into homelessness and characteristics whilst homeless. As such they are likely to require tailored support, to reflect their autistic strengths and difficulties. More work is needed to understand the mechanisms whereby ASC confers risk for becoming homelessness, in order to inform the development of preventative strategies.