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Internalizing Mental Health Issues in Individuals with Neurodevelopmental Disorders: Implications for Practitioners

  • Comorbidities (D Dewey, Section Editor)
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Abstract

Purpose of Review

The present study describes the co-occurrence of internalizing issues (e.g., depression, anxiety, and suicidal ideation and/or attempts) in two common neurodevelopmental disorders [NDDs]: ADHD and ASD.

Recent Findings

Mental health issues in individuals with ADHD and/or ASD are increasingly common, yet there is minimal literature examining how internalizing issues affect the presentation or long-term outcomes of NDDs. Depression, anxiety, and suicidal ideation and/or attempts occur across the lifespan in both ADHD and ASD.

Summary

While the mechanisms that underlie the development and maintenance of internalizing mental health issues in ADHD and ASD differ, interpersonal difficulties characteristic of both ADHD and ASD have been identified as significant contributing factors in these relationships. Given the impact of co-occurring internalizing issues on individuals with NDDs’ quality of life, determining how co-occurring internalizing issues influence diagnosis and treatment outcomes in individuals with NDDs is critical.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Mullin A, Gokhale A, Moreno-De-Luca A, Sanyal S, Waddington JL, Faundex V. Neurodevelopmental disorders: mechanisms and boundary definitions from genomes, interactomes, and proteomes. 2013;12:e329.

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

  3. Leitner Y. The co-occurrence of autism and attention deficit hyperactivity disorder in children–what do we know? Front Hum Neurosci. 2014;8:268.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015. Feb 1:peds-2014.

  5. Public Health Agency of Canada. A Report of the National Autism Spectrum Disorder Surveillance System. Government of Canada; 2018.

  6. Kern JK, Geier DA, Sykes LK, Geier MR, Deth RC. Are ASD and ADHD a continuum? A comparison of pathophysiological similarities between the disorders. J Atten Disord. 2015;19(9):805–27.

    Article  PubMed  Google Scholar 

  7. Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147–58.

  8. Owens EB, Zalecki C, Gillette P, Hinshaw SP. Girls with childhood ADHD as adults: cross-domain outcomes by diagnostic persistence. J Consult Clin Psychol. 2017;85(7):723–36.

    Article  PubMed  PubMed Central  Google Scholar 

  9. •• Rodgers J, Ofield A. Understanding, Recognising and Treating Co-occurring Anxiety in Autism. Curr Dev Disord Rep. 2018;5(1):58–64. A succinct yet comprehensive review of current understanding and issues in co-occurring ASD and anxiety .

  10. Wehmeier PM, Schacht A, Barkley RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. J Adolesc Health. 2010;46(3):209–17.

    Article  PubMed  Google Scholar 

  11. Humphreys KL, Katz SJ, Lee SS, Hammen C, Brennan PA, Najman JM. The association of ADHD and depression: mediation by peer problems and parent–child difficulties in two complementary samples. J Abnorm Psychol. 2013;122(3):854–67.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hallett V, Ronald A, Rijsdijk F, Happe F. Association of autistic-like and internalizing traits during childhood: a longitudinal twin study. Am J Psychiatry. 2010;167(7):809–17.

    Article  PubMed  Google Scholar 

  13. Schroeder JH, Cappadocia MC, Bebko JM, Pepler DJ, Weiss JA. Shedding light on a pervasive problem: a review of research on bullying experiences among children with autism spectrum disorders. J Autism Dev Disord. 2014;44(7):1520–34.

    Article  PubMed  Google Scholar 

  14. Meinzer MC, Pettit JW, Leventhal AM, Hill RM. Explaining the covariance between attention-deficit hyperactivity disorder symptoms and depressive symptoms: the role of hedonic responsivity. J Clin Psychol. 2012;68(10):1111–21.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Knouse LE, Zvorsky I, Safren SA. Depression in adults with attention-deficit/hyperactivity disorder (ADHD): the mediating role of cognitive-behavioral factors. Cogn Ther Res. 2013;37(6):1220–32.

    Article  Google Scholar 

  16. Patterson GR, Stoolmiller M. Replications of a dual failure model for boys’ depressed mood. J Consult Clin Psychol. 1991;59(4):491–8.

    Article  CAS  PubMed  Google Scholar 

  17. Cole DA. Preliminary support for a competency-based model of depression in children. J Abnorm Psychol. 1991;100(2):181–90.

    Article  CAS  PubMed  Google Scholar 

  18. Luby JL, Heffelfinger AK, Mrakotsky C, Brown KM, Hessler MJ, Wallis JM, et al. The clinical picture of depression in preschool children. J Am Acad Child Adolesc Psychiatry. 2003;42(3):340–8.

  19. Oddo LE, Knouse LE, Surman CB, Safren SA. Investigating resilience to depression in adults with ADHD. J Atten Disord. 2018;22(5):497–505.

    Article  PubMed  Google Scholar 

  20. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9(3):490–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21–31.

  22. Biederman J, Ball SW, Monuteaux MC, Mick E, Spencer TJ, McCREARY MI, et al. New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. J Am Acad Child Adolesc Psychiatry. 2008;47(4):426–34.

  23. Rohde LA, Biederman J, Busnello EA, Zimmermann H, Schmitz M, Martins S, et al. ADHD in a school sample of Brazilian adolescents: a study of prevalence, comorbid conditions, and impairments. J Am Acad Child Adolesc Psychiatry. 1999;38(6):716–22.

  24. •• Reimherr FW, Marchant BK, Gift TE, Steans TA. ADHD and anxiety: clinical significance and treatment implications. Curr Psychiatry Rep. 2017;19(12):109. This study examined the comorbidity of ADHD and anxiety, how anxiety impacts ADHD presentation, symptom overlap, and how anxiety impacts ADHD treatment across various populations.

    Article  PubMed  Google Scholar 

  25. Tsang TW, Kohn MR, Efron D, Clarke SD, Clark CR, Lamb C, et al. Anxiety in young people with ADHD: clinical and self-report outcomes. J Atten Disord. 2015;19(1):18–26.

  26. Bauermeister JJ, Shrout PE, Ramírez R, Bravo M, Alegría M, Martínez-Taboas A, et al. ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol. 2007;35(6):883–98.

  27. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatr. 2006;163(4):716–23.

  28. •• Grogan K, Gormley CI, Rooney B, Whelan R, Kiiski H, Naughton M, et al. Differential diagnosis and comorbidity of ADHD and anxiety in adults. Br J Clin Psychol. 2018;57(1):99–115. This study investigated the validity of common rating scales for purposes of differentiating between ADHD and anxiety.

  29. Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT. Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. Am J Psychiatry. 1995;152(12):1793–9.

    Article  CAS  PubMed  Google Scholar 

  30. Sobanski E, Banaschewski T, Asherson P, Buitelaar J, Chen W, Franke B, et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. J Child Psychol Psychiatry. 2010;51(8):915–23.

  31. Wang B, Brueni LG, Isensee C, Meyer T, Bock N, Ravens-Sieberer U, et al. BELLA study group. Predictive value of dysregulation profile trajectories in childhood for symptoms of ADHD, anxiety and depression in late adolescence. Eur Child Adolesc Psychiatry. 2017;25:1–8.

  32. Impey M, Heun R. Completed suicide, ideation and attempt in attention deficit hyperactivity disorder. Acta Psychiatr Scand. 2012;125(2):93–102.

    Article  CAS  PubMed  Google Scholar 

  33. Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012;80(6):1041–51.

  34. Huang KL, Wei HT, Hsu JW, Bai YM, Su TP, Li CT, et al. Risk of suicide attempts in adolescents and young adults with attention-deficit hyperactivity disorder: a nationwide longitudinal study. Br J Psychiatry. 2018;212(4):234–8.

  35. Furczyk K, Thome J. Adult ADHD and suicide. ADHD Attention Deficit and Hyperactivity Disorders. 2014;6(3):153–8.

    Article  PubMed  Google Scholar 

  36. Daviss WB, Diler RS. Suicidal behaviors in adolescents with ADHD: associations with depressive and other comorbidity, parent–child conflict, trauma exposure, and impairment. J Atten Disord. 2014;18(8):680–90.

    Article  PubMed  Google Scholar 

  37. Balazs J, Miklósi M, Keresztény Á, Dallos G, Gádoros J. Attention-deficit hyperactivity disorder and suicidality in a treatment naïve sample of children and adolescents. J Affect Disord. 2014;152:282–7.

    Article  PubMed  Google Scholar 

  38. Agosti V, Chen Y, Levin FR. Does attention deficit hyperactivity disorder increase the risk of suicide attempts? J Affect Disord. 2011;133(3):595–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Reaven J, Wainer AL. Children and adolescents with ASD and co-occurring psychiatric conditions: current trends in intervention. In: Hodapp R.H., Fidler DJ, editors. International review of research in developmental disabilities. 2015. pp. 45–90.

  40. Lefeyer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J, et al. Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord. 2006;36:849–61.

    Article  Google Scholar 

  41. Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M, et al. The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. J Autism Dev Disord. 2010;40:1361–70.

  42. Magnuson KM, Constantino JN. Characterization of depression in children with autism spectrum disorders. Journal of developmental and behavioral pediatrics: JDBP. 2011;32(4):332–40.

    Article  PubMed  Google Scholar 

  43. De-la-Iglesia M, Olivar JS. Risk factors for depression in children and adolescents with high functioning autism spectrum disorders. Sci World J. 2015;2015:1–17.

    Article  Google Scholar 

  44. Andersen PN, Skogli EW, Hovik KT, Egeland J, Øie M. Associations among symptoms of autism, symptoms of depression and executive functions in children with high-functioning autism: a 2 year follow-up study. J Autism Dev Disord. 2015;45(8):2497–507.

    Article  PubMed  Google Scholar 

  45. Stewart ME, Barnard L, Pearson J, Hasan R, O’Brien G. Presentation of depression in autism and Asperger syndrome: a review. Autism. 2006;10(1):103–16.

    Article  PubMed  Google Scholar 

  46. Storch EA, Sulkowski ML, Nadeau J, Lewin AB, Arnold EB, Mutch PJ, et al. The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders. J Autism Dev Disord. 2013;43(10):2450–9.

  47. Pouw LB, Rieffe C, Stockmann L, Gadow KD. The link between emotion regulation, social functioning, and depression in boys with ASD. Res Autism Spectr Disord. 2013;7(4):549–56.

    Article  Google Scholar 

  48. van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kerns CM, Kendall PC. Autism and anxiety: overlap, similarities, and differences. In: Handbook of autism and anxiety 2014. Springer, Champions. pp. 75–89.

  50. White SW, Roberson-Nay R. Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. J Autism Dev Disord. 2009;39(7):1006–13.

    Article  PubMed  Google Scholar 

  51. McConachie H, McLaughlin E, Grahame V, Taylor H, Honey E, Tavernor L, et al. Group therapy for anxiety in children with autism spectrum disorder. Autism. 2014;18(6):723–32.

  52. Tantam D. The challenge of adolescents and adults with Asperger syndromes. Child Adolesc Psychiatr Clin N Am. 2003;12:143–63.

    Article  PubMed  Google Scholar 

  53. Myles BS. Behavioral forms of stress management for individuals with Asperger syndrome. Child Adolesc Psychiatr Clin N Am. 2003;12:123–41.

    Article  PubMed  Google Scholar 

  54. Myles BS, Barnhill GP, Hagiwara T, Griswold DE, Simpson RL. A synthesis of studies on the intellectual, academic, social/emotional and sensory characteristics of children and youth with Asperger syndrome. Educ Train Ment Retard Dev Disabil. 2001;1:304–11.

    Google Scholar 

  55. Buck TR, Viskochil J, Farley M, Coon H, McMahon WM, Morgan J, et al. Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal on Autism and Developmental Disorders. 2014;44(12):3063–71.

  56. Gillott A, Standen PJ. Levels of anxiety and sources of stress in adults with autism. J Intellect Disabil. 2007;11(4):359–70.

    Article  PubMed  Google Scholar 

  57. Hofvander B, Delorme R, Chaste P, Nyden A, Wentz E, Stahlber O, et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry. 2009;9(35):1–9. https://doi.org/10.1186/1471-244X-9-35.

  58. Muris P, Steerneman P, Merckelbach H, Holdrinet I, Meesters C. Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of anxiety disorders. 1998 Jul 1;12(4):387–93.

    Article  CAS  PubMed  Google Scholar 

  59. Bellini S. Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities. 2004;19(2):78–86.

    Article  Google Scholar 

  60. Sze KM, Wood JJ. Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: a case report. J Contemp Psychother. 2007;37(3):133–43.

    Article  Google Scholar 

  61. Bellini S. The development of social anxiety in adolescents with autism spectrum disorders. Focus Autism Dev Disabil. 2006;21(3):138–45.

    Article  Google Scholar 

  62. Reaven J. The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents. Brain Res. 2011;1380:255–63.

    Article  CAS  PubMed  Google Scholar 

  63. Ozsivadjian A, Knott F, Magiati I. Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: a focus group study. Autism. 2012;16(2):107–21.

    Article  PubMed  Google Scholar 

  64. Lickel A, MacLean WE, Blakeley-Smith A, Hepburn S. Assessment of the prerequisite skills for cognitive behavioral therapy in children with and without autism spectrum disorders. J Autism Dev Disord. 2012;42(6):992–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Langdon PE, Murphy GH, Wilson E, Shepstone L, Fowler D, Heavens D, et al. Asperger syndrome and anxiety disorders (PAsSA) treatment trial: a study protocol of a pilot, multicentre, single-blind, randomised crossover trial of group cognitive behavioural therapy. BMJ Open. 2013;3(7):e003449.

  66. Meltzer H, Gatward R, Goodman R, Ford T. Mental health of children and adolescents in Great Britain. Int Rev Psychiatry. 2003;15(1–2):185–7.

    Article  CAS  PubMed  Google Scholar 

  67. Ghaziuddin M. Asperger syndrome: associated psychiatric and medical conditions. Focus Autism Dev Disabil. 2002;17(3):138–44.

    Article  Google Scholar 

  68. Trembath D, Germano C, Johanson G, Dissanayake C. The experience of anxiety in young adults with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities. 2012;27(4):213–24.

    Article  Google Scholar 

  69. Wood JJ, Gadow KD. Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clin Psychol Sci Pract. 2010;17(4):281–92.

    Article  Google Scholar 

  70. White SW, Mazefsky CA, Dichter GS, Chiu PH, Richey JA, Ollendick TH. Social-cognitive, physiological, and neural mechanisms underlying emotion regulation impairments: understanding anxiety in autism spectrum disorder. Int J Dev Neurosci. 2014;39:22–36.

    Article  PubMed  PubMed Central  Google Scholar 

  71. South M, Rodgers J. Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders. Front Hum Neurosci. 2017;11:20.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Piven J, Palmer P. Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. Am J Psychiatr. 1999;156(4):557–63.

    CAS  PubMed  Google Scholar 

  73. Weiss JA, Cappadocia MC, Tint A, Pepler D. Bullying victimization, parenting stress, and anxiety among adolescents and young adults with autism spectrum disorder. Autism Res. 2015;8(6):727–37.

    Article  PubMed  Google Scholar 

  74. Kerns CM, Newschaffer CJ, Berkowitz S, Lee BK. Brief report: examining the association of autism and adverse childhood experiences in the National Survey of Children’s Health: the important role of income and co-occurring mental health conditions. J Autism Dev Disord. 2017;47(7):2275–81.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Weiss JA. Transdiagnostic case conceptualization of emotional problems in youth with ASD: an emotion regulation approach. Clin Psychol Sci Pract. 2014;21(4):331–50.

    Article  Google Scholar 

  76. Segers M, Rawana J. What do we know about suicidality in autism spectrum disorders? A systematic review. Autism Res. 2014;7(4):507–21.

    Article  PubMed  Google Scholar 

  77. Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014;1(2):142–7.

    Article  PubMed  Google Scholar 

  78. Horowitz LM, Thurm A, Farmer C, Mazefsky C, Lanzillo E, Bridge JA, et al. Talking about death or suicide: prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. J Autism Dev Disord. 2017;17:1–9. https://doi.org/10.1007/s10803-017-3180-7.

  79. Demirkaya SK, Tutkunkardaş MD, Mukaddes NM. Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample. Neuropsychiatr Dis Treat. 2016;12:2921–6.

    Article  Google Scholar 

  80. Dickerson Mayes SD, Gorman AA, Hillwig-Garcia J, Syed E. Suicide ideation and attempts in children with autism. Res Autism Spectr Disord. 2013;7(1):109–19.

    Article  Google Scholar 

  81. Hannon G, Taylor EP. Suicidal behaviour in adolescents and young adults with ASD: findings from a systematic review. Clin Psychol Rev. 2013;33(8):1197–204.

    Article  PubMed  Google Scholar 

  82. Hedley D, Uljarević M, Foley KR, Richdale A, Trollor J. Risk and protective factors underlying depression and suicidal ideation in autism spectrum disorder. Depress Anxiety. 2018.

  83. Raja M, Azzoni A, Frustaci A. Autism spectrum disorders and suicidality. Clinical practice and epidemiology in mental health: CP & EMH. 2011;7:97–105.

    Article  Google Scholar 

  84. Antshel KM, Zhang-James Y, Wagner KE, Ledesma A, Faraone SV. An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Rev Neurother. 2016;16(3):279–93.

    Article  CAS  PubMed  Google Scholar 

  85. Cooper M, Martin J, Langley K, Hamshere M, Thapar A. Autistic traits in children with ADHD index clinical and cognitive problems. European child & adolescent psychiatry. 2014;23(1):23–34.

    Article  Google Scholar 

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  1. Werklund School of Education, University of Calgary, EDT 508, University Dr. NW, Calgary, AB, T2N1N4, Canada

    Jessica Baraskewich & Carly A. McMorris

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  1. Jessica Baraskewich
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Baraskewich, J., McMorris, C.A. Internalizing Mental Health Issues in Individuals with Neurodevelopmental Disorders: Implications for Practitioners. Curr Dev Disord Rep 6, 1–8 (2019). https://doi.org/10.1007/s40474-019-0154-9

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