Psychosis and autism
Recognizing Psychosis in Autism Spectrum Disorder
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Autism and Mental Health | Foundation Exit, autism in Russia
04/04/17
Review of studies on the prevalence and treatment of mental disorders in autism
Source: Autism Speaks
Epidemiological studies suggest that from 54% to 70 to 70 to 70 to 70 to 70 to 70 to 70 to 70 % of people with autism have one or more mental disorders (Simonoff 2008, Hofvander 2009, Croen 2015, Romero 2016).
With regard to their prevalence, the following data currently exist:
- Attention deficit hyperactivity disorder (ADHD) occurs in 30-61% of people with autism (Goldstein 2004, Lee 2006, Gadow 2006, Romero 2016).
- Anxiety disorders affect 11-42% of people with autism (Vasa 2016, White 2009, Croen 2015, Romero 2016).
- Depression affects 7% of children and 26% of adults with autism (Greenlee 2016, Croen 2015).
- Schizophrenia occurs in 4-35% of adults with autism (Chisolm 2015).
- Bipolar affective disorder occurs in 6-27% of people with autism (Munesue 2008, Rosenberg 2011, Vannucchi 2014, Guinchat 2015, Croen 2015). nine0003
ADHD, schizophrenia and bipolar disorder, like autism, are caused by neurobiological features of the brain that are associated with the earliest stages of its development (Munesue 2008, Sikora 2012, Rapoport 2012). As for anxiety disorders and depression, at least in part, they may be related to daily stress, social isolation, and poor overall quality of life among people with autism (Vasa 2016, Greenlee 2016).
Left untreated, psychiatric disorders can lead to a dramatic worsening of behavioral problems in autism. However, due to similar symptoms, the diagnosis of such disorders in autism can be very difficult (Levy 2010, Sikora 2012, Miodovnik 2015). For example, social avoidance in depression or schizophrenia is difficult to distinguish from social interaction disorders associated with autism. In addition, people with autism may find it difficult to identify or express their emotions and other inner experiences. nine0003
Over the past few years, autism specialists have developed guidelines for the diagnosis and treatment of some of the most common mental disorders in children, adolescents and adults with autism. The following is an overview of the latest data on this topic.
Autism and Attention Deficit Hyperactivity Disorder (ADHD)
Over the past ten years, studies have shown that 30% to 61% of people with autism also have symptoms of ADHD (Goldstein 2004, Lee 2006, Gadow 2006, Romero 2016).
By comparison, the US Centers for Disease Control and Prevention estimates that ADHD occurs in 6-7% of the general population (Perou 2013). nine0003
In addition, geneticists have discovered that many genetic variations that increase the risk of autism also increase the risk of ADHD (Lionel 2011).
Symptoms of ADHD include consistent problems with inattention, hyperactivity, and/or impulsivity that interfere with daily living, social development, and learning. People with ADHD often find it difficult to pay attention to details and make many mistakes at school or at work through sheer inattention. They often do not seem to hear when spoken to and find it difficult to organize their activities, follow instructions and complete tasks, especially when they require concentration (DSM-5 2013). nine0003
In 2012, a study of ADHD symptoms was conducted among 3,000 autistic patients aged 2 to 18 years (Sikora 2012). Multiple symptoms of ADHD have been found in more than half of children and adolescents with autism.
Further evaluation showed that the combination of ADHD and autism results in poorer daily functioning, health, and overall quality of life. At the same time, only a few of these children (11%) received ADHD treatment.
Differentiating autism and ADHD can be especially tricky because both disorders involve social interaction problems and difficulties with attention, learning, and communication. nine0003
In 2012 Pediatrics published the first guidelines for diagnosing ADHD in children and adolescents with autism, along with guidelines for selecting and evaluating ADHD medications for these patients (Mahajan 2012). The guide also provides information about the benefits and side effects of ADHD medications and their dosages in consultation with the family.
The guidelines emphasize that the decision to use drugs is very personal and should be made in consultation with the individual and/or their parents in accordance with their goals and values. nine0003
Autism and anxiety disorders
Research suggests that between 11% and 42% of people with autism suffer from one or more anxiety disorders (Vasa 2016, White 2009, Croen 2015, Romero 2016).
By comparison, the US Centers for Disease Control and Prevention estimates that 3% of children and 15% of adults in the general population have anxiety disorders (Perou 2013, Kessler 2009). These disorders include parental separation anxiety, panic disorder, and phobias (extremely intense fear of certain sounds, places, and so on). nine0003
Social anxiety—an extreme fear of new people, crowds, and social situations—is very common in children and adults with autism. Many children on the autism spectrum experience an increase in anxiety during adolescence (Bellini 2006). Although there is still very little research in adults with autism, case reports suggest that high levels of anxiety often persist throughout the life of a person with autism (Gillott 2007, Moss 2015).
Even in the absence of an anxiety disorder, many people with autism have trouble controlling their anxiety if something triggers it. For many, anxiety is closely associated with symptoms of autism, especially difficulty in social situations and increased sensory sensitivity to loud noises, lights, tastes or smells.
Problems like these can lead to a special form of anxiety where the mere thought or expectation of an anxiety-provoking situation can cause extreme anxiety. nine0003
Another important source of anxiety for people with autism is their need for routine and sameness. Changes in the daily routine or meeting strangers can cause very strong anxiety, for example, if you suddenly have to deal with a new teacher, a new tutor, or even an unfamiliar salesman.
To date, most research on anxiety in autism has been conducted in verbal children and adults with normal or high intelligence. Experts agree that more research is needed on anxiety among nonverbal or minimally verbal people, which includes one in three people with autism and/or those with an intellectual disability. nine0003
Diagnosis and treatment of anxiety in autism
In 2016, the journal Pediatrics published the first guide to diagnosing and treating anxiety in people with autism (Vasa 2016). Since it is difficult for people with autism to understand and express how they feel, very often the presence of increased anxiety must be determined by behavioral signs.
Anxiety can cause severe internal sensations, including increased heart rate, muscle tension, and abdominal pain. For a person with autism, these sensations can cause an increase in repetitive self-soothing behaviors (hand shaking, rocking, spinning, etc.) and/or destructive or self-aggressive behaviors (clothes tearing, head banging on the floor, etc.). Similarly, anxiety can be the reason why a person began to resist and refuse activities that he used to enjoy (going to the beach, birthday party, school, and so on). nine0003
The guidelines call for personalized treatment based on the patient's developmental level, including speech and intellectual development. Data are also provided on the effectiveness of a version of cognitive behavioral therapy adapted for people with autism (Wood 2009, Drahota 2011, Wood 2015). In general, cognitive-behavioral techniques include challenging negative thoughts with logic, role-playing situations, modeling bold behavior, and gradually dealing with fearful situations.
Gradual contact can begin by simply looking at a photograph of the situation. A version of psychotherapy adapted for people with autism uses many visual cues that suit the visual learning style of many people with autism. This version also uses the special interests of people with autism to increase their involvement in the psychotherapy process. For example, a therapist might use a child's favorite cartoon character to model how to deal with a fearful situation. Another example is during a therapy session, the therapist takes breaks to talk to the client about a special interest. nine0003
Some people with autism really enjoy the logical aspects of CBT. In clinical trials, cognitive behavioral therapy has proven effective for verbal people on the autism spectrum with normal to high intelligence (Wood 2009, Wood 2015, Hepburn 2016). Researchers are now working to further modify this approach to suit people with intellectual disabilities and/or speechlessness (Danial 2013). nine0003
Anxiety medications for people with autism
In some cases, counseling and behavioral therapy are not enough to relieve severe anxiety.
In these cases, the patient and/or family may consult with a qualified healthcare professional about adding an anti-anxiety medication to the treatment program. There are no medications approved specifically for the treatment of anxiety in children and adults with autism. Autism specialists typically prescribe the same drugs that have been approved for treating anxiety disorders in the general population. These include serotonin reuptake inhibitors such as Prozac and Zoloft. However, some research suggests that anti-anxiety medications may be less effective for people with autism than for other groups (Williams 2010). Perhaps the reason is that the causes of anxiety in autism differ from those in the general population. nine0003
Autism and depression
An estimated 7% of children with autism and 26% of adults with autism have depression (Greenlee 2016, Croen 2015). By comparison, 2% of children and 7% of adults in the general population in the US have depression (Perou 2013, NIMH 2015).
A recent report in the journal Pediatrics found that rates of depression among children with autism increase rapidly with age, from 5% in elementary grades to over 20% in adolescents (Greenlee 2016). It is assumed that the risk of depression is higher with higher intellectual abilities, as well as with one or more associated medical problems, primarily epilepsy and digestive problems. nine0003
The fact that levels of depression increase with age and intellectual ability suggests that painful awareness of social difficulties due to autism and isolation may be the cause of depression, the researchers note. The fact that the level of depression increases with comorbid medical problems suggests how these problems affect the quality of life in autism.
The authors urge healthcare professionals to consider standard screening for symptoms of depression for all adolescents and adults with autism, especially if they have normal or high intelligence or additional medical problems. nine0003
Diagnosis of Depression in Autism
Signs and symptoms of depression include chronic feelings of sadness, hopelessness, worthlessness, inner emptiness and/or irritability.
Also common: social isolation, slowness of movement or speech, restlessness, difficulty concentrating or sitting still. In the most severe cases, depression may include frequent thoughts of death and/or suicide.
However, diagnosing depression in people with autism can be particularly difficult (Gotham 2015). A flat, emotionless facial expression, for example, is characteristic of both autism and depression. The same applies to irritability and social isolation. As a result, it can be difficult to recognize depression behind the manifestations of autism. In addition, many people with autism find it very difficult to identify and express their feelings. For these reasons, autism professionals have begun working to develop and test modified methods for diagnosing depression in children and adolescents on the autism spectrum (Sterling 2015). nine0003
Depression, autism, and suicide
In 2012, researchers at Penn College of Medicine reported that 14% of children with autism under the age of 16 "sometimes" or "very often" thought or attempted suicide—28 times more likely than than children of the same age with typical development (Mayes 2013).
The increase in suicidal tendencies becomes significant after 10 years of age, and was most associated with depressive symptoms. Neither the severity of autism nor the level of intelligence affected this level. The authors of the study urge medical professionals to screen all children with autism for suicidal thoughts and attempts, and to inform parents about such risks. nine0003
Treating depression in people with autism
Cognitive behavioral therapy may well be successful in treating depression in adolescents and adults with autism (Kuroda 2013). These findings are based on a large body of research on the effectiveness of a modified version of cognitive behavioral therapy for extreme and chronic anxiety in autism.
There are no drugs approved to treat depression specifically in patients with autism, so usually psychiatrists prescribe the same drugs for people with autism as for other patients. However, more research is needed, as a 2011 study suggests that antidepressant side effects are more common among people with autism (Boyd 2011).
The most common side effects are drowsiness, nervous agitation, increased irritability, increased motor activity and digestive problems. nine0003
Autism and Schizophrenia
In the 1960s, psychiatrists mistakenly believed that autism was a form of childhood schizophrenia (DSM II 1968). However, by the 1990s, psychiatry had made a clear distinction between these disorders (Rapoport 2009).
Although autism and schizophrenia are distinct disorders, they share biological characteristics. The roots of both disorders seem to be related to the development of the child's brain even before birth. The same factors are associated with an increased risk of both autism and schizophrenia. These include infectious and inflammatory diseases of the mother during pregnancy, as well as the age of both parents at the time of conception (Patterson 2009, Menon 2011, Insel 2010). Research has also identified many genetic risk factors for both disorders. In other words, there are many genetic variations that can increase the risk of both autism and schizophrenia (Guilmatre 2009, McCarthy 2014).
Autism and schizophrenia also have similar symptoms, for example, with both disorders, it can be difficult for a person to understand speech, as well as understand the thoughts and feelings of other people. The most obvious difference between schizophrenia and autism is psychosis, which usually includes hallucinations. In addition, the main symptoms of autism always appear very early - autism can be diagnosed between the ages of 1 and 3 years. The symptoms of schizophrenia usually appear in young adults. nine0003
Many physicians have reported that they have identified previously undiagnosed autism in adults with schizophrenia and vice versa. However, studies on how often autism and schizophrenia coexist have produced conflicting results (Chisolm 2015). Studies have shown that schizophrenia occurs in 4-35% of adults with autism, and that 4-60% of people with schizophrenia have autism. In comparison, schizophrenia occurs in about 1.1% of the general population, and autism occurs in about 1.
5% (NIMH/Regier 1993, Baio 2014).
The authors of the studies cited above believe that screening for autism among adults diagnosed with schizophrenia is necessary, and that adolescents and adults with autism should also be monitored for the possible emergence of symptoms of schizophrenia.
Bipolar affective disorder
Bipolar affective disorder is a mood disorder formerly called "manic depressive disorder" or "manic depression". People with bipolar affective disorder may experience periods of agitation called mania and periods of depression. While some people have only episodes of mania, most people with this disorder have alternating states of mania and depression, and they can also be extremely irritable. nine0003
Research shows that children and adults with autism are at increased risk of bipolar disorder (Munesue 2008, Rosenberg 2011, Vannucchi 2014, Guinchat 2015). However, data on the prevalence of this disorder among people with autism vary widely, ranging from 6% to 27%.
By comparison, about 4% of the general population has bipolar affective disorder (Kessler 1994).
However, some leading autism experts suggest that bipolar disorder is often misdiagnosed in people with autism. The reason is that autism may be associated with symptoms that resemble bipolar disorder – increased motor activity, irritability, sleep disturbances (Witwer 2014). Experts urge mental health professionals to be careful and try to separate the symptoms of genuine bipolar disorder from those of autism by looking at when the symptoms started and how long they lasted. For example, a child with autism may be very energetic and obsessive during social interactions throughout childhood. In this case, the child's tendency to talk to strangers and make inappropriate comments is consistent with his autism, not symptoms of manic mood swings. nine0003
Treatment of bipolar disorder in autism
Some bipolar medications are problematic and even dangerous to use if the patient has difficulty recognizing and expressing their feelings, which is common in autism.
For example, lithium in rare cases can be toxic and even life-threatening. The first signs of such toxicity are increased thirst and trembling. Anticonvulsants that can stabilize mood, such as valproic acid, may be a safer treatment for patients with autism (Witwer 2014). nine0003
In addition, antipsychotics such as risperidone and aripiprazole have been approved for the treatment of irritability in children with autism, although both drugs can lead to weight gain and an increased risk of diabetes.
We hope that the information on our website will be useful or interesting for you. You can support people with autism in Russia and contribute to the work of the Foundation by clicking on the "Help" button.
Psychiatry, Comorbidities
How common are psychiatric disorders in autism
10.10.19
A new study showed that 8 mental health disorders are much more common in people in the Autism spectrum
Source: SPECTRUM News
9000 Scientific Research suggests that eight various mental disorders are much more common in people with autism (1).
Some mental health problems are known to often accompany autism, but estimates of their prevalence among autistic people vary widely (2). (See also: Autism and Mental Health Issues.) nine0003
A new study was conducted by pooling and analyzing data from different studies. The authors conducted separate statistical analyzes for various conditions: attention deficit hyperactivity disorder (ADHD), anxiety disorders, depression, schizophrenia and psychosis, bipolar affective disorder, obsessive-compulsive disorder, impulse control and behavior disorders, and sleep and wake disorders.
"This study has provided a more holistic picture of elevated levels of the major and most common psychiatric disorders," says Stephanie Ameis, lead author of the study and professor of psychiatry at the University of Toronto in Canada. nine0003
The study also determined that people on the autism spectrum are at increased risk of depression, bipolar disorder and schizophrenia as they age.
Ameis and colleagues included in their analysis the results of studies of 10,000 people, which were conducted from January 1993 to February 2019, and which included diagnosed mental disorders among people with autism. Studies with 20 or fewer people were excluded from the analysis, as well as studies where the diagnosis was not made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases. nine0003
We then excluded from the analysis those studies whose authors asked about the presence of psychiatric disorders during the lifetime, since they did not provide data on the age of diagnosis, the determination of which was one of the objectives of this analysis. As a result, the analysis was carried out on the data of 96 studies. The results were published in the August issue of the Lancet Psychiatry.
The average prevalence of various mental disorders, according to the study, was as follows:
- Attention deficit hyperactivity disorder (ADHD) occurs in 28% of people on the autism spectrum.
