Journal of Autism and Developmental Disorders

, Volume 46, Issue 1, pp 74–82 | Cite as

Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis

  • I. Carina Gillberg
  • Adam Helles
  • Eva Billstedt
  • Christopher Gillberg
Original Paper


We examined comorbid psychiatric and neurodevelopmental disorders in fifty adult males (mean age 30 years) with Asperger syndrome (AS) diagnosed in childhood and followed up prospectively for almost two decades (13–26 years). Only three of the 50 men had never met criteria for an additional psychiatric/neurodevelopmental diagnosis and more than half had ongoing comorbidity (most commonly either ADHD or depression or both). Any psychiatric comorbidity increased the risk of poorer outcome. The minority of the AS group who no longer met criteria for a full diagnosis of an autism spectrum disorder were usually free of current psychiatric comorbidity. The high rate of psychiatric/neurodevelopmental comorbidities underscores the need for a full psychiatric/neurodevelopmental assessment at follow-up of males with AS.


Autism spectrum disorder Asperger syndrome Psychiatric disorder Depression ADHD DCD Schizophrenia Neurodevelopmental Long-term follow-up 



The study was supported by funding from: Centre for Research and Development in Gavleborg and the Child and Adolescent Psychiatric Clinic in Gavle, VG Region Scientific Fund, the Jerring Fund, Wilhelm and Martina Lundgren Foundation, Petter Silfverskiold Foundation, Golje Foundation, AnnMarie and Per Ahlqvist Foundation, the Swedish Child Neuropsychiatry Science Foundation, and the Gillberg Neuropsychiatry Centre.

Author contribution

ICG, EB and CG designed the study. ICG, AH and EB performed the data collection. AH perfomed all the analysis. ICG, AH and CG wrote the manuscript. EB critically edited the manuscript. AH is guarantor of this work and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflict of interest.


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  3. Beck, A., & Steer, R. (1996). Beck depression inventory manual—Swedish version. Fagernes: Psykologiforlaget.Google Scholar
  4. Buck, T. R., Viskochil, J., Farley, M., Coon, H., McMahon, W. M., Morgan, J., et al. (2014). Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(12), 3063–3071.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Cederlund, M., & Gillberg, C. (2004). One hundred males with Asperger syndrome: A clinical study of background and associated factors. Developmental Medicine and Child Neurology, 46(10), 652–660.PubMedCrossRefGoogle Scholar
  6. Cederlund, M., Hagberg, B., Billstedt, E., Gillberg, I. C., & Gillberg, C. (2008). Asperger syndrome and autism: A comparative longitudinal follow-up study more than 5 years after original diagnosis. Journal of Autism and Developmental Disorders, 38(1), 72–85.PubMedCrossRefGoogle Scholar
  7. Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science, 333, 959–964.PubMedPubMedCentralCrossRefGoogle Scholar
  8. Ghaziuddin, M., Weidmer-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger syndrome: A preliminary report. Journal of Intellectual Disability Research, 42(Pt 4), 279–283.PubMedGoogle Scholar
  9. Gillberg, C. (1991). Clinical and neurobiological aspects of Asperger syndrome in six family studies. In U. Frith (Ed.), Autism and Asperger Syndrome. Cambridge: Cambridge University Press.Google Scholar
  10. Gillberg, C. (2002). A guide to Asperger syndrome. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  11. Gillberg, C. (2010). The ESSENCE in child psychiatry: Early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Research in Developmental Disabilities, 31(6), 1543–1551.PubMedCrossRefGoogle Scholar
  12. Gillberg, C. (2014). ESSENCE gathers the diagnoses into a whole. Lakartidningen, 111(39), 1643–1646.PubMedGoogle Scholar
  13. Gillberg, C., & Billstedt, E. (2000). Autism and Asperger syndrome: Coexistence with other clinical disorders. Acta Psychiatrica Scandinavica, 102(5), 321–330.PubMedCrossRefGoogle Scholar
  14. Gillberg, C., & Cederlund, M. (2005). Asperger syndrome: Familial and pre-and perinatal factors. Journal of Autism and Developmental Disorders, 35(2), 159–166.PubMedCrossRefGoogle Scholar
  15. Gillberg, C., & Fernell, E. (2014). Autism plus versus autism pure. Journal of Autism and Developmental Disorders, 44(12), 3274–3276.PubMedCrossRefGoogle Scholar
  16. Gillberg, I. C., & Gillberg, C. (1989). Asperger syndrome—Some epidemiological considerations: A research note. Journal of Child Psychology and Psychiatry, 30(4), 631–638.PubMedCrossRefGoogle Scholar
  17. Helles, A., Gillberg, C. I., Gillberg, C., & Billstedt, E. (2015). Asperger syndrome in males over two decades: Stability and predictors of diagnosis. Journal of Child Psychology and Psychiatry, 56(6), 711–718.PubMedCrossRefGoogle Scholar
  18. Hofvander, B., Delorme, R., Chaste, P., Nyden, A., Wentz, E., Stahlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 35.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Hurtig, T., Kuusikko, S., Mattila, M. L., Haapsamo, H., Ebeling, H., Jussila, K., et al. (2009). Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism. Autism, 13(6), 583–598.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65.PubMedPubMedCentralCrossRefGoogle Scholar
  22. Kirby, A., Sugden, D., & Purcell, C. (2014). Diagnosing developmental coordination disorders. Archives of Disease in Childhood, 99(3), 292–296.PubMedCrossRefGoogle Scholar
  23. Leekam, S., Libby, S., Wing, L., Gould, J., & Gillberg, C. (2000). Comparison of ICD-10 and Gillberg’s criteria for Asperger syndrome. Autism, 4(1), 11–28.CrossRefGoogle Scholar
  24. Leekam, S. R., Libby, S. J., Wing, L., Gould, J., & Taylor, C. (2002). The diagnostic interview for social and communication disorders: Algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. Journal of Child Psychology and Psychiatry, 43(3), 327–342.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. Lugnegard, T., Unenge Hallerback, M., Hjarthag, F., & Gillberg, C. (2013). Social cognition impairments in Asperger syndrome and schizophrenia. Schizophrenia Research, 143(2–3), 277–284.PubMedCrossRefGoogle Scholar
  27. 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(9), 1080–1093.PubMedCrossRefGoogle Scholar
  28. Mazzone, L., Postorino, V., De Peppo, L., Fatta, L., Lucarelli, V., Reale, L., et al. (2013). Mood symptoms in children and adolescents with autism spectrum disorders. Research in Developmental Disabilities, 34(11), 3699–3708.PubMedCrossRefGoogle Scholar
  29. Mazzone, L., Ruta, L., & Reale, L. (2012). Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges. Annals of General Psychiatry, 11(1), 16.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Mukaddes, N. M., Herguner, S., & Tanidir, C. (2010). Psychiatric disorders in individuals with high-functioning autism and Asperger’s disorder: Similarities and differences. The World Journal of Biological Psychiatry, 11(8), 964–971.PubMedCrossRefGoogle Scholar
  31. Paquette-Smith, M., Weiss, J., & Lunsky, Y. (2014). History of suicide attempts in adults with Asperger syndrome. Crisis, 35(4), 273–277.PubMedCrossRefGoogle Scholar
  32. Politte, L. C., Henry, C. A., & McDougle, C. J. (2014). Psychopharmacological interventions in autism spectrum disorder. Harvard Review of Psychiatry, 22, 76–92.PubMedCrossRefGoogle Scholar
  33. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.PubMedGoogle Scholar
  34. Skokauskas, N., & Gallagher, L. (2010). Psychosis, affective disorders and anxiety in autistic spectrum disorder: Prevalence and nosological considerations. Psychopathology, 43(1), 8–16.PubMedCrossRefGoogle Scholar
  35. Smits-Engelsman, B. C., Blank, R., van der Kaay, A. C., Mosterd-van der Meijs, R., Vlugt-van den Brand, E., Polatajko, H. J., et al. (2013). Efficacy of interventions to improve motor performance in children with developmental coordination disorder: A combined systematic review and meta-analysis. Developmental Medicine and Child Neurology, 55(3), 229–237.PubMedCrossRefGoogle Scholar
  36. Swanson, J. M. (1992). School-based assessments and intervention for ADD students. Irvine, CA: KC Publications.Google Scholar
  37. Takara, K., & Kondo, T. (2014). Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: A case–control study. Annals of General Psychiatry, 13, 33. doi: 10.1186/s12991.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Unenge Hallerback, M., Lugnegard, T., & Gillberg, C. (2012). Is autism spectrum disorder common in schizophrenia? Psychiatry Research, 198(1), 12–17.PubMedCrossRefGoogle Scholar
  39. Wechsler, D. (2002). WAIS-III, Wechsler Adult Intelligence Scale, third edition: Technical Manual. San Antonio, TX: Psychological Corporation.Google Scholar
  40. Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11(1), 115–129.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • I. Carina Gillberg
    • 1
  • Adam Helles
    • 1
  • Eva Billstedt
    • 1
  • Christopher Gillberg
    • 1
  1. 1.Gillberg Neuropsychiatry Centre, Institute of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden

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