Wide Gaps Seen in Identification & Care
A new comprehensive review of scientific studies from the past 15 years has confirmed the extensive burden of psychiatric conditions that accompany a diagnosis of autism. The review found high rates of anxiety, depression, bipolar and mood disorders, schizophrenia and other psychotic disorders, suicide behavior, eating disorders, substance abuse, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and disruptive, impulse-control, and conduct disorders in autism populations.
“Such mental health disparities resulting from the coexistence of these psychiatric morbidities may critically affect the mental health status, daily life, and overall quality of living among people who are already suffering from a complex neuropsychiatric condition like ASD,” state the authors.
While the higher rates of psychiatric conditions than the general population affected all age groups, from children and adolescents to adults, it was more pronounced in adults. The widening gap with age could be due to difficulties in diagnosing mental health disorders in children with autism, as professionals are ill equipped to separate the autism behaviors from mental illness ones. It could also be due to autistic individuals not receiving adequate treatment when young, making mental health worse in adulthood. Either cause suggests the need to strengthen psychiatric care at the early stages to lower the severity of lifetime psychiatric burden.
The study has implications for families, service providers, researchers and policymakers.
Families and caregivers should be informed about how different psychiatric conditions can present in individuals with ASD. They should be aware of and advocate for available interventions to promote positive mental health, independently of the typical behavioral, speech and occupational therapies used for autism.
Healthcare providers should be aware of the likelihood of psychiatric issues in autism patients. They should expand their capacity to screen, diagnose and treat accordingly across the lifespan. Most autism therapists are not trained in mental health and most mental health therapists have low autism knowledge. “It is essential to empower the health workforce so that they can contribute within their professional scopes and collectively provide holistic care to individuals with ASD,” state the authors.
Healthcare policymakers should rethink the existing models of care. Provision of care and health systems financing are usually separate for neurodevelopmental disorders and other psychiatric disorders. A child or adult with autism may be able to access behavior therapy but not have coverage or access to mental health therapies, creating persistent gaps.
For the research field, the authors observed wide differences across reviews of prevalence rates for similar psychiatric disorders. Many reasons could account for the variability, such as changes in diagnostic definitions over time, inconsistent diagnostic practices, differences in study sampling strategies, and study population differences by age, economic status or geography. The authors recommend more observational studies and better clinical descriptions to improve accurate counting, as well as identification of autism subgroups which are more affected.
The study synthesized findings from peer-reviewed reviews of original research studies, a process known as an umbrella review, or a systematic review of the reviews. The umbrella incorporated findings from 26 studies, including 14 systematic reviews and 12 meta-analyses, conducted between 2006 and 2020. This is the first umbrella review that informs the prevalence of comorbid psychiatric disorders in ASD from evidence-based reviews.
Following established guidelines for evidence-based reviews, the umbrella used more than two reviewers at each step of the review, thus minimizing biases and methodological challenges. It used a critical appraisal checklist to assess the methodological quality of the included studies, finding 14 reviews of high quality, 12 reviews of medium quality, and no studies of low quality.
Reference
Md Mahbub Hossain, Nusrat Khan, Abida Sultana, Abida Sultana et al. Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Research. Available online 18 March 2020.
