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Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders.

Journal article
Authors Björn Hofvander
Richard Delorme
Pauline Chaste
Agneta Nydén
Elisabet Wentz
Ola Ståhlberg
Evelyn Herbrecht
Astrid Stopin
Henrik Anckarsäter
Christopher Gillberg
Maria Råstam
Marion Leboyer
Published in BMC Psychiatry
Volume 9
Pages 35
ISSN 1471-244X
Publication year 2009
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Pages 35
Language en
Links dx.doi.org/10.1186/1471-244X-9-35
Keywords Adolescent, Adult, Age Factors, Ambulatory Care, Asperger Syndrome, Diagnosis, Epidemiology, Autistic Disorder, Diagnosis, Epidemiology, Psychology, Child, Child Development Disorders, Pervasive, Diagnosis, Epidemiology, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Intelligence, Classification, Interpersonal Relations, Male, Mental Disorders, Diagnosis, Epidemiology, Middle Aged, Mood Disorders, Diagnosis, Epidemiology, Nonverbal Communication, Psychology, Psychiatric Status Rating Scales, Statistics & numerical data, Psychometrics
Subject categories Child and adolescent psychiatry

Abstract

BACKGROUND: Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs. METHODS: Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians. RESULTS: Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects. CONCLUSION: ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.

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