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Autismus bei erwachsenen Menschen mit geistiger Behinderung

Autism in adults with intellectual disabilities

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Zusammenfassung

Nach Angaben der WHO besteht bei 1–3% der Bevölkerung eine geistige Behinderung (GB). Bei etwa jedem 4. Menschen mit GB besteht zusätzlich eine Autismusspektrumstörung (24,6%, Mittelwert aus 19 Studien, n=9675), wobei die Prävalenz mit dem Grad der GB ansteigt (IQ 50–70: 9,9%, IQ<50: 31,7%). Besonders für die behandelnden Ärzte von psychisch kranken oder verhaltensauffälligen Menschen mit GB ist es daher wichtig, die Störung zu erkennen, differenzialdiagnostisch abzuklären und therapeutische Schritte einzuleiten.

Die Diagnose basiert – unabhängig vom IQ – auf einer vor dem 3. Lebensjahr begonnenen Beeinträchtigung in den Kernbereichen soziale Interaktion, Kommunikation und eingeschränkten, repetitiven Interessen (frühkindlicher oder Kanner-Autismus). Auch bei Menschen mit einer GB kann Autismus als zusätzliche, eigenständige Störung diagnostiziert werden, wobei die kommunikativen und sozialen Fähigkeiten in Relation zum Intelligenz- und Entwicklungsniveau zu setzen sind.

Aufgrund der reduzierten Ausdrucks- und Introspektionsfähigkeit, der erhöhten Prävalenz körperlicher und psychischer Erkrankungen, der erschwerten Anamnesebedingungen und der u. U. atypischen Symptompräsentation ist die Diagnosestellung bei erwachsenen Menschen mit GB eine besondere Herausforderung.

Der vorliegende Artikel beschreibt die Symptomatik, das diagnostische Vorgehen, häufige Komorbiditäten und Differenzialdiagnosen sowie therapeutische Möglichkeiten und Grenzen bei erwachsenen Menschen mit Intelligenzminderung und Autismusverdacht.

Summary

According to the World Health Organization (WHO) the estimated prevalence of intellectual disabilities (ID) is about 1–3% and 1 out of 4 individuals with ID suffer from an additional autistic spectrum disorder (ASD) (arithmetic mean 24.6%, 19 studies, n=9,675) whereby the prevalence increases with the severity of ID (IQ 50–70: 9.9%, IQ<50: 31.7%). Therefore, it is of particular importance for physicians treating individuals with ID who have psychiatric disorders or behavioral problems to take ASD into account as a differential diagnosis so that appropriate treatment can be initiated.

Irrespective of the IQ the diagnosis is based on an impairment of social interaction and communication and restricted repetitive interests presenting before the age of 3 (infantile or Kanner autism). ASD can be diagnosed as a separate disorder in adults with ID, however, the social and communicative abilities in respect of the cognitive and developmental level have to be considered.

Due to reduced verbal capacity, high prevalence of physical and mental disorders, difficulties in taking the past medical history and presentation of atypical symptoms, the diagnostic assessment for autism in adults with ID is challenging.

This article describes the typical symptoms, diagnostic approach, frequent comorbidities, differential diagnoses treatment options and their limitations for adults with ID suspected of having ASD.

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Danksagung

Wir danken Frau Dipl. Psych. R. Symalla, Frau Dr. I. Dziobek, Frau Dr. T. Voss, Herrn Prof. Dr. Dr. H.-C. Steinhausen und Herrn Dr. C. Schade für die kritische Durchsicht des Artikels. Darüber hinaus danken wir Frau Prof. Dr. K. Schumacher für die fachliche Beratung, dem gesamten Pflege- und Therapeutenteam des Behandlungszentrums, insbesondere Frau Linda Kienitz, für die tatkräftige Unterstützung bei der Therapie- und Förderplanung, und ganz besonders unseren Patienten und ihren Angehörigen für ihre engagierte, oft zeitaufwendige Mithilfe bei der Diagnostik und Behandlung.

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  1. Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Psychiatrische Institutsambulanz, Bereich: Geistige Behinderung, Herzbergstraße 79, 10365, Berlin, Deutschland

    T. Sappok, T. Bergmann, H. Kaiser & A. Diefenbacher

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  1. T. Sappok
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  2. T. Bergmann
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  3. H. Kaiser
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  4. A. Diefenbacher
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Correspondence to T. Sappok.

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Sappok, T., Bergmann, T., Kaiser, H. et al. Autismus bei erwachsenen Menschen mit geistiger Behinderung. Nervenarzt 81, 1333–1345 (2010). https://doi.org/10.1007/s00115-010-3098-1

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