Abstract
To systematically examine the patterns of psychiatric comorbidity and functioning in clinically referred adults with autism spectrum disorders (ASD). Psychiatrically referred adults with and without ASD were compared on measures assessing for psychiatric comorbidity and psychosocial functioning. Sixty-three adults with ASD participated in the study (mean age: 29 ± 11 years). Adults with ASD in their lifetime suffered from a higher burden of psychiatric disorders (6 ± 3.4 vs. 3.5 ± 2.7; p < 0.001) including major depressive disorder and multiple anxiety disorders, and were functionally more impaired with a significant proportion having received both counseling and pharmacotherapy. Adults with ASD have high levels of psychiatric comorbidity and dysfunction comparable to a clinically referred population of adults without ASD.
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Allen, M. H., Hirschfeld, R. M., Wozniak, P. J., Baker, J. D., & Bowden, C. L. (2006). Linear relationship of valproate serum concentration to response and optimal serum levels for acute mania. The American Journal of Psychiatry, 163(2), 272–275.
Amaral, D. G., & Corbett, B. A. (2003). The amygdala, autism and anxiety. Novartis Foundation Symposium, 251, 177–187. discussion 187–197, 281–197.
Baron-Cohen, S., Ring, H. A., Bullmore, E. T., Wheelwright, S., Ashwin, C., & Williams, S. C. (2000). The amygdala theory of autism. Neuroscience and Biobehavioral Reviews, 24(3), 355–364.
Billstedt, E., Gillberg, I. C., & Gillberg, C. (2005). Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35(3), 351–360.
Blacher, J., & McIntyre, L. L. (2006). Syndrome specificity and behavioural disorders in young adults with intellectual disability: Cultural differences in family impact. Journal of Intellectual Disability Research: JIDR, 50(Pt 3), 184–198. doi:10.1111/j.1365-2788.2005.00768.x.
Canitano, R. (2006). Self injurious behavior in autism: Clinical aspects and treatment with risperidone. Journal of Neural Transmission (Vienna, Austria: 1996), 113(3), 425–431. doi:10.1007/s00702-005-0337-x.
Chugani, D. C., Muzik, O., Behen, M., Rothermel, R., Janisse, J. J., Lee, J., et al. (1999). Developmental changes in brain serotonin synthesis capacity in autistic and nonautistic children. Annals of Neurology, 45(3), 287–295.
de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37(5), 877–886. doi:10.1007/s10803-006-0215-x.
Diagnostic and Statistical Manual of Mental Disorders (1994) (4th ed.). Washington, DC: American Psychiatric Association.
Ebert, D., Speck, O., Konig, A., Berger, M., Hennig, J., & Hohagen, F. (1997). 1H-magnetic resonance spectroscopy in obsessive-compulsive disorder: Evidence for neuronal loss in the cingulate gyrus and the right striatum. Psychiatry Research, 74(3), 173–176.
Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33(6), 766–771.
First, M., Gibbon, M., Williams, J., & Spitzer, R. (1996). Structured clinical interview for DSM-IV disorders: SCID SCREENPatient Questionnaire Computer Program. Washington, DC: American Psychiatric Press.
Frazier, J. A., Biederman, J., Bellordre, C. A., Garfield, S. B., Geller, B., Coffey, B. J., et al. (2001). Should the diagnosis of Attention-Deficit/Hyperactivity Disorder be considered in children with Pervasive Development Disorder? Journal of Attention Disorders, 4(4), 203–211.
Ghaziuddin, M., Weidmer-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger syndrome: A preliminary report. Journal of Intellectual Disability Research: JIDR, 42(Pt 4), 279–283.
Ghaziuddin, M., & Zafar, S. (2008). Psychiatric comorbidity of adults with autism spectrum disorders. Clinical Neuropsychiatry, 5(1), 9–12.
Goldstein, S., & Schwebach, A. J. (2004). The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: Results of a retrospective chart review. Journal of Autism and Developmental Disorders, 34(3), 329–339.
Green, M. J., & Benzeval, M. (2010). Ageing, social class and common mental disorders: Longitudinal evidence from three cohorts in the West of Scotland. Psychological Medicine, 41(3), 565–574.
Green, J., Gilchrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder. Journal of Autism and Developmental Disorders, 30(4), 279–293.
Handen, B. L., Johnson, C. R., & Lubetsky, M. (2000). Efficacy of methylphenidate among children with autism and symptoms of attention-deficit hyperactivity disorder. Journal of Autism and Developmental Disorders, 30(3), 245–255.
Hollingshead, A. B. (1975). Four factor index of social status. New Haven: Yale Press.
Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6, 65–70.
Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., et al. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40(11), 1361–1370. doi:10.1007/s10803-010-0996-9.
Juranek, J., Felipek, P. A., Berenji, G. R., Modahl, C., Osann, K., & Spence, M. A. (2006). Association between amygdala volume and anxiety level: Magnetic resonance imaging (MRI) study in autistic children. Journal of Child Neurology, 21(12), 1051–1058.
Kanne, S. M., Christ, S. E., & Reiersen, A. M. (2009). Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders, 39(6), 827–833. doi:10.1007/s10803-008-0688-x.
Kim, Y. S., Leventhal, B. L., Koh, Y. J., Fombonne, E., Laska, E., Lim, E. C., et al. (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry,. doi:10.1176/appi.ajp.2011.10101532.
Kim, J., Szatmari, P., Bryson, S., Streiner, D., & Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.
Kobayashi, R., & Murata, T. (1998). Behavioral characteristics of 187 young adults with autism. Psychiatry and Clinical Neurosciences, 52(4), 383–390.
Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395–1403. doi:10.1542/peds.2009-1522.
Langen, M., Durston, S., Staal, W. G., Palmen, S. J., & van Engeland, H. (2007). Caudate nucleus is enlarged in high-functioning medication-naive subjects with autism. Biological Psychiatry, 62(3), 262–266.
Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36(8), 1101–1114. doi:10.1007/s10803-006-0147-5.
Leckman, J., Sholomskas, D., Thompson, D., Belanger, A., & Weissman, M. (1982). Best estimate of lifetime psychiatric diagnosis: A methodological study. Archives of General Psychiatry, 39, 879–883.
LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23, 155–184. doi:10.1146/annurev.neuro.23.1.155.
Lee, D. O., & Ousley, O. Y. (2006). Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 16(6), 737–746. doi:10.1089/cap.2006.16.737.
Levitt, J. G., O’Neill, J., Blanton, R. E., Smalley, S., Fadale, D., McCracken, J. T., et al. (2003). Proton magnetic resonance spectroscopic imaging of the brain in childhood autism. Biological Psychiatry, 54(12), 1355–1366.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861. doi:10.1007/s10803-006-0123-0.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Lugnegard, T., Hallerback, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32, 1910–1917.
McCracken, J. T., McGough, J., Shah, B. G., Cronin, P., Hong, D., Aman, M. G., et al. (2002). Risperidone in children with autism and serious behavioral problems. The New England Journal of Medicine, 347(5), 314–321.
Munesue, T., Ono, Y., Mutoh, K., Shimoda, K., Nakatani, H., & Kikuchi, M. (2008). High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: A preliminary study of 44 outpatients. Journal of Affective Disorders, 111(2–3), 170–175. doi:10.1016/j.jad.2008.02.015.
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12(4), 387–393.
Murphy, D. G., Critchley, H. D., Schmitz, N., McAlonan, G., Van Amelsvoort, T., Robertson, D., et al. (2002). Asperger syndrome: A proton magnetic resonance spectroscopy study of brain. Archives of General Psychiatry, 59(10), 885–891. doi:10.1001/archpsyc.59.10.885.
Nacewicz, B. M., Dalton, K. M., Johnstone, T., Long, M. T., McAuliff, E. M., Oakes, T. R., et al. (2006). Amygdala volume and nonverbal social impairment in adolescent and adult males with autism. Archives of General Psychiatry, 63(12), 1417–1428. doi:10.1001/archpsyc.63.12.1417.
Network R. U. o. P. P. R. A. (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62(11), 1266–1274. doi:10.1001/archpsyc.62.11.1266.
Orvaschel, H. (1994). Schedule for affective disorder and schizophrenia for school-age children epidemiologic version (5th ed.). Ft. Lauderdale: Nova Southeastern University, Center for Psychological Studies,
Posey, D. J., Wiegand, R. E., Wilkerson, J., Maynard, M., Stigler, K. A., & McDougle, C. J. (2006). Open-label atomoxetine for attention-deficit/hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 16(5), 599–610.
Rojas, D. C., Peterson, E., Winterrowd, E., Reite, M. L., Rogers, S. J., & Tregellas, J. R. (2006). Regional gray matter volumetric changes in autism associated with social and repetitive behavior symptoms. BMC Psychiatry, 6, 56. doi:10.1186/1471-244X-6-56.
Rosenberg, D. R., MacMaster, F. P., Keshavan, M. S., Fitzgerald, K. D., Stewart, C. M., & Moore, G. J. (2000). Decrease in caudate glutamatergic concentrations in pediatric obsessive-compulsive disorder patients taking paroxetine. Journal of the American Academy of Child and Adolescent Psychiatry, 39(9), 1096–1103.
Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. The British Journal of Psychiatry: The Journal Of Mental Science, 186, 525–528. doi:10.1192/bjp.186.6.525.
Ryden, E., & Bejerot, S. (2008). Autism spectrum disorders in an adult psychiatric population. A naturalistic cross-sectional controlled study. Clinical Neuropsychiatry, 5(1), 13–21.
Scarone, S., Colombo, C., Livian, S., Abbruzzese, M., Ronchi, P., Locatelli, M., et al. (1992). Increased right caudate nucleus size in obsessive-compulsive disorder: Detection with magnetic resonance imaging. Psychiatry Research, 45(2), 115–121.
Schultz, R. T. (2005). Developmental deficits in social perception in autism: The role of the amygdala and fusiform face area. International Journal of Developmental Neuroscience: The Official Journal of the International Society for Developmental Neuroscience, 23(2–3), 125–141. doi:10.1016/j.ijdevneu.2004.12.012.
Schumann, C. M., Hamstra, J., Goodlin-Jones, B. L., Lotspeich, L. J., Kwon, H., Buonocore, M. H., et al. (2004). The amygdala is enlarged in children but not adolescents with autism; the hippocampus is enlarged at all ages. Journal of Neuroscience, 24(28), 6392–6401. doi:10.1523/JNEUROSCI.1297-04.200424/28/6392.
Sears, L. L., Vest, C., Mohamed, S., Bailey, J., Ranson, B. J., & Piven, J. (1999). An MRI study of the basal ganglia in autism. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 23(4), 613–624. doi:10.1016/S0278-5846(99)00020-2.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi:10.1097/CHI.0b013e318179964f.
Stahlberg, O., Soderstrom, H., Rastam, M., & Gillberg, C. (2004). Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. Journal of Neural Transmission (Vienna, Austria: 1996), 111(7), 891–902. doi:10.1007/s00702-004-0115-1.
StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.
Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128. doi:10.1007/s10802-007-9165-9.
Szatmari, P., Bartolucci, G., & Bremner, R. (1989). Asperger’s syndrome and autism: Comparison of early history and outcome. Developmental Medicine and Child Neurology, 31(6), 709–720.
Tsakanikos, E., Costello, H., Holt, G., Bouras, N., Sturmey, P., & Newton, T. (2006). Psychopathology in adults with autism and intellectual disability. Journal of Autism and Developmental Disorders, 36(8), 1123–1129. doi:10.1007/s10803-006-0149-3.
Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence (WASI) (4th ed.). San Antonio, TX: The Psychological Corporation.
Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15(3), 477–496. doi:10.1089/cap2005.15.477.
Wozniak, J., Biederman, J., Faraone, S. V., Frazier, J., Kim, J., Millstein, R., et al. (1997). Mania in children with pervasive developmental disorder revisited. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1552–1559. doi:10.1016/S0890-8567(09)66564-3. discussion 1559–1560.
Yoshida, Y., & Uchiyama, T. (2004). The clinical necessity for assessing attention deficit/hyperactivity disorder (AD/HD) symptoms in children with high-functioning pervasive developmental disorder (PDD). European Child and Adolescent Psychiatry, 13(5), 307–314. doi:10.1007/s00787-004-0391-1.
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This work has been funded in part by the Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorders and the Norma Fine Pediatric Psychopharmacology Fellowship Fund.
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Joshi, G., Wozniak, J., Petty, C. et al. Psychiatric Comorbidity and Functioning in a Clinically Referred Population of Adults with Autism Spectrum Disorders: A Comparative Study. J Autism Dev Disord 43, 1314–1325 (2013). https://doi.org/10.1007/s10803-012-1679-5
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DOI: https://doi.org/10.1007/s10803-012-1679-5