Psychiatric Disorders in Children With Autism Spectrum Disorders: Prevalence, Comorbidity, and Associated Factors in a Population-Derived Sample

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Abstract

Objective

Autism spectrum disorders are now recognized to occur in up to 1% of the population and to be a major public health concern because of their early onset, lifelong persistence, and high levels of associated impairment. Little is known about the associated psychiatric disorders that may contribute to impairment. We identify the rates and type of psychiatric comorbidity associated with ASDs and explore the associations with variables identified as risk factors for child psychiatric disorders.

Method

A subgroup of 112 ten- to 14-year old children from a population-derived cohort was assessed for other child psychiatric disorders (3 months' prevalence) through parent interview using the Child and Adolescent Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety disorders, depressive disorders, oppositional defiant and conduct disorders, attention-deficit/hyperactivity disorder, tic disorders, trichotillomania, enuresis, and encopresis were identified.

Results

Seventy percent of participants had at least one comorbid disorder and 41% had two or more. The most common diagnoses were social anxiety disorder (29.2%, 95% confidence interval [Cl)] 13.2-45.1), attention-deficit/hyperactivity disorder (28.2%, 95% Cl 13.3-43.0), and oppositional defiant disorder (28.1 %, 95% Cl 13.9-42.2). Of those with attention-deficit/hyperactivity disorder, 84% received a second comorbid diagnosis. There were few associations between putative risk factors and psychiatric disorder.

Conclusions

Psychiatric disorders are common and frequently multiple in children with autism spectrum disorders. They may provide targets for intervention and should be routinely evaluated in the clinical assessment of this group. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):921-929.

Section snippets

Sample

The Special Needs and Autism Project sample was drawn from a total population cohort of 56,946 children. All of those with a current clinical diagnosis of pervasive developmental disorder (N = 255) or considered to be at risk for being an undetected case by virtue of having a Statement of Special Educational Needs (N = 1,515) were surveyed using the Social Communication Questionnaire (SCQ25). A Statement of Special Educational Needs is a legal document issued by U.K. education authorities when

Results

Of the 112 children included, 98 were male (7:1 male:female ratio), with a mean age of 11.5 years (range 10-13.9). Fifty children (39 male) had an ICD-10 diagnosis of other pervasive developmental disorders and 62 children (59 male) of childhood autism; 106 (95%) were white British.

Discussion

To our knowledge, this is the first study of comorbid psychopathology in ASDs using an epidemiological, population-derived sample, and a standardized interview measure to determine the rates of DSM-IV disorders. The present research confirms the high rates of many psychiatric disorders in children with ASDs previously reported in less systematic studies. Although it is difficult to make direct comparisons with other samples, findings from an overlapping age group in the general population

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    The study was funded by the Wellcome Trust. The authors are grateful to the children and families who participated in the study and to the clinical teams whose collaboration made the study possible. They thank Iris Carcani-Rathwell, Greg Pasco, Samantha Ross, Emma Rowley, Vicky Slonims, and Martha Turner for their help with assessments and Gordon Keeler for running the diagnostic algorithms. The study was approved by the South East Multicentre Research Ethics Committee.

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