Associations between co‐occurring conditions and age of autism diagnosis: Implications for mental health training and adult autism research

Abstract

Adult autism studies are increasingly comprised of later-diagnosed adults, yet little is known about how these adults compare to those diagnosed earlier in life. The present study examines medical and psychiatric conditions endorsed by autistic adults and documents differences between those diagnosed with ASD in childhood versus adulthood, as well as across age groups and sex at birth. 4657 legally independent adults (ages 18-85, M = 33.4 years) with professional ASD diagnoses who completed a medical questionnaire were drawn from the Simons Powering Autism Research Knowledge (SPARK) study. Chi square analyses, t-tests, and logistic regressions were used to compare medical and psychiatric conditions between age groups, sex at birth and adults diagnosed in childhood (before age 21) versus adulthood (at or after 21 years). Overall number of conditions endorsed as being diagnosed by a professional was high, with an average of 1.69 (SD = 2.01) medical or developmental and 2.98 (SD = 2.29) psychiatric conditions reported across the sample. Females were more likely to endorse psychiatric conditions (OR = 1.68). Adultdiagnosed adults were more likely to endorse psychiatric conditions (OR = 2.71) and reported more lifetime psychiatric diagnoses (M = 3.15, SD = 2.23) than their childhood-diagnosed counterparts (M = 2.81, SD = 2.33). These findings underscore the need for research to better understand and treat co-occurring psychiatric conditions in autistic adults and report and consider the age of diagnosis in adult autism samples. Moreover, results suggest it is imperative that mental health professionals receive autism training to promote accurate differential diagnosis and equitable access to mental health care for autistic adults with co-occurring psychiatric conditions. Lay SummaryIn a large sample of independent autistic adults, those diagnosed with ASD after 21 years of age indicated having more psychiatric diagnoses than those diagnosed before 21 years of age. This highlights the importance of considering age of ASD diagnosis in research and underscores a need for autism training in the broader mental health field.

A mixed methods study of autistic adults' mental health therapy experiences

“…The current study was conducted to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health therapy strategies. Consistent with prior research (Croen et al, 2015;Fombonne et al, 2020;Jadav & Bal, 2022;Lai et al, 2019;Lugo-Marín et al, 2019;Rydzewska et al, 2018), mental health problems were highly prevalent in the current sample. Over three fourths of the sample had a current mental health condition, most commonly anxiety (58.7%) and depression (48.8%).…”

“…Recent large-scale caregiver-and self-report survey studies have found lifetime prevalence of psychiatric disorders ranging from 72% among dependent autistic adults (Fombonne et al, 2020) to 87% among independent autistic adults (Jadav & Bal, 2022), with lifetime prevalence of anxiety disorders ranging from 41% to 66% and affective disorders ranging from to 28% to 58% (Fombonne et al, 2020;Jadav & Bal, 2022). Depression and anxiety have significant negative effects on well-being, quality of life, and day-to-day functioning (Gotham, Brunwasser, & Lord, 2015;Mason et al, 2018;Mazurek, 2014;Oakley et al, 2021), leading to increased risk for suicidality among autistic adults (Cassidy et al, 2018;Hedley et al, 2018;Jokiranta-Olkoniemi et al, 2021), and underscoring the urgent need for effective and appropriate outpatient treatment.…”

“…Meta‐analytic results indicate that approximately 54% of autistic adults meet criteria for a co‐occurring psychiatric disorder based on Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases diagnostic classifications (Lugo‐Marín et al, 2019) and that lifetime prevalence of anxiety (42%) and depression (37%) are remarkably high (Hollocks et al, 2019). Recent large‐scale caregiver‐ and self‐report survey studies have found lifetime prevalence of psychiatric disorders ranging from 72% among dependent autistic adults (Fombonne et al, 2020) to 87% among independent autistic adults (Jadav & Bal, 2022), with lifetime prevalence of anxiety disorders ranging from 41% to 66% and affective disorders ranging from to 28% to 58% (Fombonne et al, 2020; Jadav & Bal, 2022). Depression and anxiety have significant negative effects on well‐being, quality of life, and day‐to‐day functioning (Gotham, Brunwasser, & Lord, 2015; Mason et al, 2018; Mazurek, 2014; Oakley et al, 2021), leading to increased risk for suicidality among autistic adults (Cassidy et al, 2018; Hedley et al, 2018; Jokiranta‐Olkoniemi et al, 2021), and underscoring the urgent need for effective and appropriate outpatient treatment.…”

Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample

“…As this is the approach adopted by the present study and several others in this relatively young field [ 22 , 30 , 31 , 52 – 54 ], findings are likely unrepresentative of all within the diverse autistic community. It is possible, given the differences noted between late- and early-diagnosed samples in mental health and wellbeing [ 125 , 126 ], that risk and protective factors for NSSI, suicidality and psychopathology differ as a function of age at diagnosis. The topography of NSSI and its relation to psychopathology and suicide risk remains an important target for future research, which could adopt more tailored recruitment strategies for underrepresented groups (e.g.…”

Case report: Treatment-resistant depression, multiple trauma exposure and suicidality in an adolescent female with previously undiagnosed Autism Spectrum Disorder

“…Also, females seem to mask more their autistic traits than males, a phenomenon known as camouflage (18), which has been associated to higher rates of distress, depression and suicidality in both adolescents and adults with ASD (19)(20)(21). Conversely, an earlier ASD diagnosis has shown a protective effect on depression and selfharm behaviors (22,23), potentially enabling timely interventions and social support, and reducing the risk of traumatic experiences (24), that have been linked to mood symptoms and suicidality in ASD (25,26). Since current evidence is heavily based on male samples, providing information on the female autism phenotype could reduce mis-and missed-diagnosis rates and prevent secondary comorbidities in this population.…”