Psychiatric Comorbidity and Medication Use in Adults with Autism Spectrum Disorder

Abstract

The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980’s statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6 %) met criteria for a current psychiatric disorder; 89 participants (69.0 %) met lifetime criteria for a psychiatric disorder. Caregivers reported a psychiatric diagnosis in 44 participants (34.1 %). Anxiety disorder had the highest current and lifetime prevalence (39.5 and 52.7 %, respectively). Participants with intellectual disability (n = 94, 72.8 %) were significantly less likely to have community-based diagnoses of anxiety (χ2 = 5.37, p = 0.02) or depression (χ2 = 13.18, p < 0.001) reported by caregivers. Seventy-six participants (58.9 %) were taking ≥1 psychotropic medication. Comorbid psychiatric disorders occur frequently in adults with ASD, though identifying these disorders poses a challenge in community settings. A greater understanding of the presentation of these conditions within this population will increase assessment validity and the potential for efficacious intervention.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Aman, M. G., Lam, K. S., & Van Bourgondien, M. E. (2005). Medication patterns in patients with autism: Temporal, regional, and demographic influences. Journal of Child and Adolescent Psychopharmacology, 15(1), 116–126.

    PubMed  Article  Google Scholar 

  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision). Washington, DC: American Psychiatric Association.

  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  5. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators. (2007). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR, 56(SS-1), 12–28.

  6. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Principal Investigators. (2009). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2006. MMWR, 58(SS-10), 1–20.

  7. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators (2012) Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, 14 Sites, United States, 2008. MMWR, 61(3), 1–19.

  8. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR, 63(2), 1–21.

  9. 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.

    PubMed  Article  Google Scholar 

  10. Bradley, E., & Bolton, P. (2006). Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. British Journal of Psychiatry, 189, 361–366.

    PubMed  Article  Google Scholar 

  11. Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36(7), 863–870.

    PubMed  Article  Google Scholar 

  12. Coury, D. L., Anagnostou, E., Manning-Courtney, P. M., Reynolds, A., Cole, L., McCoy, R., et al. (2012). Use of psychotropic medication in children and adolescents with autism spectrum disorders. Pediatrics, 130, 69–76.

    Article  Google Scholar 

  13. de Bruin, E. I., Ferdinand, R. F., Meester, S., deNijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37(5), 877–886.

    PubMed  Article  Google Scholar 

  14. Devine, M., Taggart, L., & McLornian, P. (2009). Screening for mental health problems in adults with learning disabilities using the Mini PAS-ADD Interview. British Journal of Learning Disabilities, 38, 252–258.

    Article  Google Scholar 

  15. Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(4), 739–747.

    PubMed  Article  Google Scholar 

  16. Esbensen, A. J., Greenberg, J. S., Seltzer, M. M., & Aman, M. G. (2009). A longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1339–1349.

    PubMed Central  PubMed  Article  Google Scholar 

  17. Fletcher, R., Loschen, E., Stavrakaki, C., & First, M. (Eds.). (2007). Diagnostic manual-intellectual disability (DM-ID): A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD Press.

    Google Scholar 

  18. Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 32(4), 299–306.

    PubMed  Article  Google Scholar 

  19. Ghaziuddin, M., Weidmer-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger syndrome: A preliminary report. Journal of Intellectual Disability Research, 42(4), 279–283.

    PubMed  Article  Google Scholar 

  20. Gillott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities, 11(4), 359–370.

    PubMed  Article  Google Scholar 

  21. Gray, K., Keating, C., Taffe, J., & Brereton, A. (2012). Trajectory of behavior and emotional problems in autism. American Journal on Intellectual Developmental Disorders, 117(2), 121–133.

    Article  Google Scholar 

  22. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 35.

    PubMed Central  PubMed  Article  Google Scholar 

  23. Holden, B. B., & Gitlesen, J. P. (2004). The association between severity of intellectual disability and psychiatric symptomatology. Journal of Intellectual Disability Research, 48(6), 556–562.

    PubMed  Article  Google Scholar 

  24. Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229.

    PubMed  Article  Google Scholar 

  25. Hutton, J., Goode, S., Murphy, M., Le Couteur, A., & Rutter, M. (2008). New-onset psychiatric disorders in individuals with autism. Autism, 12(4), 373–390.

    PubMed  Article  Google Scholar 

  26. Janssen, R., & Maes, B. (2013). Psychometric evaluation of a Dutch version of the Mini PAS-ADD for assessing psychiatric disorders in adults with different levels of intellectual disability. Journal of Intellectual Disability Research, 57(8), 689–702.

    Article  Google Scholar 

  27. 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.

    PubMed  Article  Google Scholar 

  28. Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A., et al. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. Journal of Autism and Developmental Disorders, 43(6), 1314–1325.

    PubMed  Article  Google Scholar 

  29. Lainhart, J. E. (1999). Psychiatric problems in individuals with autism, their parents, and siblings. International Review of Psychiatry, 11, 278–298.

    Article  Google Scholar 

  30. Langworthy-Lam, K. S., Aman, M. G., & Van Bourgondien, M. E. (2002). Prevalence and patterns of use of psychoactive medicines in individuals with autism in the Autism Society of North Carolina. Journal of Child Adolescent Psychopharmacology, 12(4), 311–321.

    PubMed  Article  Google Scholar 

  31. 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.

    PubMed  Article  Google Scholar 

  32. LoVullo, S. V., & Matson, J. L. (2009). Comorbid psychopathology in adults with autism spectrum disorders and intellectual disabilities. Research in Developmental Disabilities, 30(6), 1288–1296.

    PubMed  Article  Google Scholar 

  33. Lugnegård, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917.

    PubMed  Article  Google Scholar 

  34. Mattila, M. L., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., et al. (2010). Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: A community-and clinic-based Study. Journal of Autism and Developmental Disorders, 40, 1080–1093.

    PubMed  Article  Google Scholar 

  35. Melville, C. A., Cooper, S. A., Morrison, J., Smiley, E., Allan, L., Jackson, A., et al. (2008). The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities. Journal of Autism and Developmental Disorders, 38(9), 1676–1688.

    PubMed  Article  Google Scholar 

  36. Miller, J. S., Bilder, D., Farley, M., Coon, H., Pinborough-Zimmerman, J., Jenson, W., et al. (2013). Autism spectrum disorder reclassified: A second look at the 1980s Utah/UCLA autism epidemiologic study. Journal of Autism and Developmental Disorders, 43(1), 200–210.

    PubMed  Article  Google Scholar 

  37. Morgan, C. N., Roy, M., & Chance, P. (2003). Psychiatric comorbidity and medication use in autism: A community survey. Psychiatric Bulletin of the Royal College of Psychiatrists, 27, 378–381.

    Article  Google Scholar 

  38. Moss, S. (2002). The Mini PAS-ADD interview pack. Brighton: Pavilion.

    Google Scholar 

  39. Moss, S., Prosser, H., Costello, H., Simpson, N., Patel, P., Rowe, S., et al. (1998). Reliability and validity of the PAS-ADD checklist for detecting psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42, 173–183.

    PubMed  Article  Google Scholar 

  40. Prosser, H., Moss, S., Costello, H., Simpson, N., Patel, P., & Rowe, S. (1998). Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42(4), 264–272.

    PubMed  Article  Google Scholar 

  41. Rice, C. E., Baio, J., Van Naarden Braun, K., Doernberg, N., Meaney, F. J., Kirby, R. S., et al. (2007). A public health collaboration for the surveillance of autism spectrum disorders. Paediatric and Perinatal Epidemiology, 21(2), 179–190.

    PubMed  Article  Google Scholar 

  42. Ritvo, E. R., Freeman, B. J., Pingree, C., Mason-Brothers, A., Jorde, L., Jenson, W. R., et al. (1989). The UCLA-University of Utah epidemiologic survey of autism: Prevalence. American Journal of Psychiatry, 146(2), 194–199.

    PubMed  Google Scholar 

  43. Roid, G. H. (2003). Stanford–Binet Intelligence Scales (5th ed.). Itasca, IL: Riverside.

    Google Scholar 

  44. Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. British Journal of Psychiatry, 186, 525–528.

    PubMed  Article  Google Scholar 

  45. Ryden, E., & Bejerot, S. (2008). Autism spectrum disorders in an adult psychiatric population: A naturalistic cross-sectional controlled study. Journal of Clinical Neuropsychology, 5(1), 13–21.

    Google Scholar 

  46. 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. Journey of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.

    Article  Google Scholar 

  47. Skokauskas, N., & Gallagher, L. (2012). Mental health aspects of autistic spectrum disorders in children. Journal of Intellectual Disability Research, 56(3), 248–257.

    PubMed  Article  Google Scholar 

  48. 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, 111(7), 891–902.

    PubMed  Article  Google Scholar 

  49. Sterling, L., Dawson, G., Estes, A., & Greenson, J. (2008). Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(6), 1011–1018.

    PubMed  Article  Google Scholar 

  50. Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and Asperger syndrome: A review. Autism, 10(1), 103–116.

    PubMed  Article  Google Scholar 

  51. 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.

    PubMed  Article  Google Scholar 

  52. Van Naarden Braun, K., Pettygrove, S., Daniels, J., Miller, L., Nicholas, J., Baio, J., et al. (2007). Evaluation of a methodology for a collaborative multiple source surveillance network for autism spectrum disorders—Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. Surveillance Summaries: Morbidity and Mortality Weekly Report, 56(1), 29–40.

    Google Scholar 

  53. Wechsler, D. (2008). Wechsler Adult Intelligence Scale-Fourth Edition. San Antonio, Texas: Pearson.

    Google Scholar 

  54. World Health Organization. (1992). Schedules for clinical assessment in neuropsychiatry (SCAN-I). Geneva: World Health Organization.

    Google Scholar 

  55. Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., & Murphy, C. (2003). Prevalence of autism in a US metropolitan area. JAMA Psychiatry, 289(1), 49–55.

    Google Scholar 

Download references

Acknowledgments

We thank the individuals and caretakers who have participated in the ongoing research projects at the Utah Autism Research Program. We would like to acknowledge Drs. Riva-Ariella Ritvo and Edward Ritvo for their contribution to the original autism prevalence study and preservation of this important resource. This work was supported in part by the National Institute of Mental Health R01 MH094400 and Autism Speaks. Drs. Bilder and McMahon have served as consultants to BioMarin. Dr. McMahon has a patent with Lineagen. Tara Buck, MD and Deborah Bilder, MD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Deborah A. Bilder.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Buck, T.R., Viskochil, J., Farley, M. et al. Psychiatric Comorbidity and Medication Use in Adults with Autism Spectrum Disorder. J Autism Dev Disord 44, 3063–3071 (2014). https://doi.org/10.1007/s10803-014-2170-2

Download citation

Keywords

  • Autism spectrum disorder
  • Psychiatric comorbidity
  • Psychotropic medication
  • Intellectual disability