Medical comorbidities in children and adolescents with autism spectrum disorders and attention deficit hyperactivity disorders: a systematic review

Abstract

Somatic disorders occur more often in adult psychiatric patients than in the general adult population. However, in child and adolescent psychiatry this association is unclear, mainly due to a lack of integration of existing data. To address this issue, we here present a systematic review on medical comorbidity in the two major developmental disorders autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) and formulate clinical recommendations. The literature was searched using the PubMed and PsycINFO databases (2000–1 May 2016) with the keywords “[((child and adolescent) AND (Autism OR Attention Deficit Hyperactivity Disorder* OR ADHD)) AND (“Cardiovascular Diseases” [Mesh] OR “Endocrine System Diseases” [Mesh] OR “Immune System Diseases” [Mesh] OR “Neurobehavioral Manifestations” [Mesh] OR “Gastrointestinal Disorders” [Mesh] OR Somatic OR Autoimmune disease OR Nervous system disease OR Infection OR Infectious disease)]. Two raters independently assessed the quality of the eligible studies. The initial search identified 5278 articles. Based on inclusion and exclusion criteria 104 papers were selected and subsequently subjected to a quality control. This quality was assessed according to a standardized and validated set of criteria and yielded 29 studies for inclusion. This thorough literature search provides an overview of relevant articles on medical comorbidity in ADHD and/or ASD, and shows that medical disorders in these children and adolescents appear to be widespread. Those who work with children with ASD and/or ADHD should be well aware of this and actively promote routine medical assessment. Additionally, case–control studies and population-based studies are needed to provide reliable prevalence estimates. Future studies should furthermore focus on a broader evaluation of medical disorders in children and adolescents with ADHD and/or ASD to improve treatment algorithm in this vulnerable group.

Research Issues Involving the Biology of Autism

“…Widespread interest in medical comorbidities began in the mid-1990s, and over the past 20 years, studies have indicated that many if not most individuals on the autism spectrum suffer from one or more medical problems (Muskens et al, 2017).…”

Evidence-based support for autistic people across the lifespan: Maximizing potential, minimizing barriers, and optimizing the person-environment fit

“…Across the lifespan, autistic individuals have a higher probability than people in the general population to have other health conditions (Davignon et al, 2018, Kohane et al, 2012, Muskens et al, 2017, Soke et al, 2018, Weiss et al, 2018, likely due to shared biological causes and/or the experiences of living with autism (Lai et al, 2014, Vorstman et al, 2017. Common co-occurring neurodevelopmental challenges include intellectual disability, attention-deficit/hyperactivity disorder (ADHD), tic disorders, learning disorders (Lundstrom et al, 2015) and genetic anomalies (Richards et al, 2015, Vorstman et al, 2017.…”

“…Common co-occurring neurodevelopmental challenges include intellectual disability, attention-deficit/hyperactivity disorder (ADHD), tic disorders, learning disorders (Lundstrom et al, 2015) and genetic anomalies (Richards et al, 2015, Vorstman et al, 2017. Most common physical conditions include epilepsy (Bolton et al, 2011, Jokiranta et al, 2014, immunological disorders (eg, atopy), gastrointestinal (eg, OSF preprint first posted online July 19, 2018; https://dx.doi.org/10.31219/osf.io/8z5rvThe copyright holders for this preprint (which was not peer-reviewed) are the authors constipation) and sleep problems (Bauman, 2010, Croen et al, 2015, Jones et al, 2016, Kohane et al, 2012, Muskens et al, 2017. Most common mental health issues include anxiety, irritability, self-injurious behaviour, obsessive-compulsive disorder, mood disorders (including depression), suicidal risk, eating disorders, and psychotic disorders (Howes et al, 2018, Lai et al, 2014.…”

Treating Children with ASD: The Perspective of Caregivers

“…As a result, children with ASD are treated with polypharmacy regimens often off-label. ASD and Attention Deficit Hyperactivity Disorder (ADHD) co-occurrence, formally recognized only in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), has presented clinicians with challenges in terms of effective treatments (10). _________________________________________ Pharmacists are in a unique position to help caregivers of ASD children in counselling regarding the use of prescription and over-the-counter medications, particularly in the complexity of attempting to control a myriad of symptoms.…”