Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.
Beck, A., & Steer, R. (1996). Beck depression inventory manual—Swedish version. Fagernes: Psykologiforlaget.
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.
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.
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.
Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science, 333, 959–964.
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.
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.
Gillberg, C. (2002). A guide to Asperger syndrome. Cambridge: Cambridge University Press.
Gillberg, C. (2010). The ESSENCE in child psychiatry: Early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Research in Developmental Disabilities, 31(6), 1543–1551.
Gillberg, C. (2014). ESSENCE gathers the diagnoses into a whole. Lakartidningen, 111(39), 1643–1646.
Gillberg, C., & Billstedt, E. (2000). Autism and Asperger syndrome: Coexistence with other clinical disorders. Acta Psychiatrica Scandinavica, 102(5), 321–330.
Gillberg, C., & Cederlund, M. (2005). Asperger syndrome: Familial and pre-and perinatal factors. Journal of Autism and Developmental Disorders, 35(2), 159–166.
Gillberg, C., & Fernell, E. (2014). Autism plus versus autism pure. Journal of Autism and Developmental Disorders, 44(12), 3274–3276.
Gillberg, I. C., & Gillberg, C. (1989). Asperger syndrome—Some epidemiological considerations: A research note. Journal of Child Psychology and Psychiatry, 30(4), 631–638.
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.
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.
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.
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.
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.
Kirby, A., Sugden, D., & Purcell, C. (2014). Diagnosing developmental coordination disorders. Archives of Disease in Childhood, 99(3), 292–296.
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.
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.
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.
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.
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.
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.
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.
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.
Paquette-Smith, M., Weiss, J., & Lunsky, Y. (2014). History of suicide attempts in adults with Asperger syndrome. Crisis, 35(4), 273–277.
Politte, L. C., Henry, C. A., & McDougle, C. J. (2014). Psychopharmacological interventions in autism spectrum disorder. Harvard Review of Psychiatry, 22, 76–92.
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.
Skokauskas, N., & Gallagher, L. (2010). Psychosis, affective disorders and anxiety in autistic spectrum disorder: Prevalence and nosological considerations. Psychopathology, 43(1), 8–16.
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.
Swanson, J. M. (1992). School-based assessments and intervention for ADD students. Irvine, CA: KC Publications.
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.
Unenge Hallerback, M., Lugnegard, T., & Gillberg, C. (2012). Is autism spectrum disorder common in schizophrenia? Psychiatry Research, 198(1), 12–17.
Wechsler, D. (2002). WAIS-III, Wechsler Adult Intelligence Scale, third edition: Technical Manual. San Antonio, TX: Psychological Corporation.
Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11(1), 115–129.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors have any conflict of interest.
Rights and permissions
About this article
Cite this article
Gillberg, I.C., Helles, A., Billstedt, E. et al. Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis. J Autism Dev Disord 46, 74–82 (2016). https://doi.org/10.1007/s10803-015-2544-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-015-2544-0