Autism and Chronic Ill Health: An Observational Study of Symptoms and Diagnoses of Central Sensitivity Syndromes in Autistic Adults

Abstract

Background Autistic adults, particularly women, are more likely to experience chronic ill health than the general population. Central sensitivity syndromes (CSS) are a group of related conditions that are thought to include an underlying sensitisation of the central nervous system; heightened sensory sensitivity is a common feature. Anecdotal evidence suggests autistic adults may be more prone to developing a CSS. This study aimed to investigate the occurrence of CSS diagnoses and symptoms in autistic adults, and to explore whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, or sex. MethodsParticipants included 982 autistic adults (male = 409, female = 563, other = 9, mean age = 44.5) registered at the Netherlands Autism Register, who completed questionnaires assessing autistic traits, sensory sensitivity, CSS, physical and mental health symptoms. The reliability and validity of the Central Sensitization Inventory (CSI) in an autistic sample was established using exploratory and confirmatory factor analyses. Chi2 analyses, independent t-tests, ANOVA, hierarchical regression analysis and path analysis were used to analyse relationships between CSS symptoms, autistic traits, measures of mental health and wellbeing, sensory sensitivity, age and assigned sex. Results21% of participants reported one or more CSS diagnoses, and 60% scored at or above the clinical cut-off for a CSS. Nonbinary and female autistics were more likely to report a CSS diagnosis and experienced more CSS symptoms than males. Sensory sensitivity, anxiety, age and sex were significant predictors of CSS symptoms, with sensory sensitivity and anxiety fully mediating the relationship between autistic traits and CSS symptoms. Limitations Although this study included a large sample of autistic adults, we did not have a control group or a CSS only group. ConclusionsCSS diagnoses and symptoms appear to be very common in the autistic population. Increased awareness of an association between autism and CSS should inform clinicians and guide diagnostic practice, particularly for females where CSS is common and autism under recognised.

Current and Lifetime Somatic Symptom Burden Among Transition-aged Autistic Young Adults

“…Additionally, the positive relationship between autistic traits and somatic symptom burden remained after controlling for age, sex, and generalized anxiety, in contrast to prior findings in an adult autistic sample 10 . However, it is notable that the prior study also controlled for self-reported Table 3.…”

“…As a measure of total somatic symptom burden across the remaining symptoms, we took the mean score of all nonmissing items (i.e., up to 14 items for females and 13 for males), multiplied that score by 15, and rounded to the nearest integer value in order to approximate the 0-30 distribution of the original PHQ-15 questionnaire. Total scores on this measure can be qualitatively interpreted as minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (≥15) 15 .…”

“…In the general population, somatic symptoms represent the most common cause of outpatient medical visits, as well as the predominant reason why individuals with psychiatric conditions present to primary care settings 3 . However, with the notable exceptions of gastrointestinal symptoms 4 and sleep disturbances 5,6 , somatic symptoms are infrequently studied in the autistic population [7][8][9][10] . Furthermore, no studies to date have investigated the prevalence of individual somatic symptoms or the natural history of these symptoms in autistic adults.…”

“…In this study, we used data from the Simons Powering Autism Research Knowledge (SPARK 11 ) participant pool to assess self-reported current and lifetime somatic symptoms in a relatively large sample of transition-aged young adults on the autism spectrum. On the basis of previous studies in autistic individuals [7][8][9][10] and the general population 12,13 , we hypothesized that young adults on the autism spectrum would report elevated levels of all somatic symptoms examined 7,8 , with higher somatic symptom burden associated with older age 10,12,13 , female sex 10,12,13 , higher levels of autistic traits 10 , elevated depression and anxiety symptoms 9,10,12,13 , and reduced quality of life 10,12,13 . In addition, we attempted to replicate results of a previous study wherein the relationship between autistic traits and somatic symptom burden was no longer significant after controlling for anxiety 10 .…”

“…On the basis of previous studies in autistic individuals [7][8][9][10] and the general population 12,13 , we hypothesized that young adults on the autism spectrum would report elevated levels of all somatic symptoms examined 7,8 , with higher somatic symptom burden associated with older age 10,12,13 , female sex 10,12,13 , higher levels of autistic traits 10 , elevated depression and anxiety symptoms 9,10,12,13 , and reduced quality of life 10,12,13 . In addition, we attempted to replicate results of a previous study wherein the relationship between autistic traits and somatic symptom burden was no longer significant after controlling for anxiety 10 . By describing the presence, severity, and clinical correlates of somatic symptoms in autistic individuals, the current study sought to further characterize these potentially major contributors to health care utilization and quality of life in this population.…”