The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders

Kohane, Isaac S.; McMurry, Andrew; Weber, Griffin M; MacFadden, Douglas; Rappaport, Leonard; Kunkel, Louis M.; Bickel, Jonathan; Wattanasin, Nich; Spence, Sarah; Murphy, Shawn N.; Churchill, Susanne

doi:10.1371/journal.pone.0033224

Cited by 488 publications

(400 citation statements)

References 47 publications

(61 reference statements)

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“…14,15,33,34 Most notably, we found a considerably higher prevalence of seizure disorders in adults with ASD in all age groups compared to the general population. We also found higher rates of depression, hypertension, and allergies in young adults with ASD, which approached the prevalence of the general population in our older age groups.…”

Section: Discussionmentioning

confidence: 55%

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation

et al. 2015

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BACKGROUND: Children and adolescents with autism spectrum disorder (ASD) have many well-known health concerns, yet health conditions in adults with ASD remain poorly defined. OBJECTIVE: To examine health conditions and functional status in adults with ASD and identify factors associated with health and functional status across age cohorts. DESIGN AND SUBJECTS: We collected cross-sectional data from 255 adult subjects aged 18 to 71 years with ASD using the Rochester Health Status Survey IV (RHSS-IV), a 58-item validated survey instrument. We used the National Health and Nutritional Examination Survey and National Health Interview Survey to provide comparative prevalence rates in the general population. RESULTS: Compared to the general population, young adults aged 18-29 with ASD had a substantially higher prevalence of seizure disorder (11.2 % vs. 1.4 %; p= 0.002), depression (16.4 % vs. 6.4 %; p=0.007), hypertension (12.9 % vs. 6.3 %; p=0.05), and allergies (39.7 % vs. 8.4 %; p<0.001). In contrast, young adults with ASD had considerably lower rates of sexually transmitted illness (STI) (0.9 % vs. 4.3 %; p=0.03), tobacco use (5.2 % vs. 31.9 %; p<0.001), and alcohol misuse (0.9 % vs. 11.9 %; p<0.001). Adults 40 and over with ASD also had higher rates of seizure disorder (29.2 % vs. 1.7 %; p < 0.001), lower tobacco use (2.8 % vs. 24.5 %; p<0.001), and lower alcohol misuse (1.4 % vs. 18.2 %; p<0.001) compared to the general population. Amongst the 55 % of participants with a documented IQ score, 91 % had an intellectual disability (IQ < 70). Within the cohort aged 40 years old and older, only 54.2 % were independent with eating, 43.0 % independent with dressing, and 43.1 % independent with bathing. Lower IQ and depression were associated with lower functional status. CONCLUSIONS: Adults with ASD have a high prevalence of seizure disorders and depression, but low rates of STIs, tobacco use, and alcohol misuse. Within our cohort, the majority of older adults with ASD required some assistance with activities of daily living.

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Section: Discussionmentioning

confidence: 55%

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation

et al. 2015

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“…The prevalence of the comorbidities described in here are higher in the ASD population than in the general pediatric population, even in tertiary care centers, 5 and echo the differences between essential and complex ASDs described by Miles et al 33 Thus, although these co-occurrence patterns may occur for many reasons (a disease, or its treatment, may make the patient more vulnerable for another; genetic variants may have pleiotropic effects that include autism and other comorbidities; and environmental insults may also have pleiotropic effects), we do not believe these findings are simply incidental.…”

Section: Discussionmentioning

confidence: 64%

“…[1][2][3][4][5] With the prevalence of autism near 1%, 6 understanding this comorbidity burden is especially important (not least because of the clinical resources this burden entails). Understanding the co-occurrence patterns among comorbidities in ASD is the first step for uncovering the underlying etiologies associated with ASD and stratifying the risk of various conditions across individuals with ASD.…”

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confidence: 99%

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Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis

2014

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WHAT'S KNOWN ON THIS SUBJECT: Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders. WHAT THIS STUDY ADDS:Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. abstract OBJECTIVE: The distinct trajectories of patients with autism spectrum disorders (ASDs) have not been extensively studied, particularly regarding clinical manifestations beyond the neurobehavioral criteria from the Diagnostic and Statistical Manual of Mental Disorders. The objective of this study was to investigate the patterns of cooccurrence of medical comorbidities in ASDs.METHODS: International Classification of Diseases, Ninth Revision codes from patients aged at least 15 years and a diagnosis of ASD were obtained from electronic medical records. These codes were aggregated by using phenotype-wide association studies categories and processed into 1350-dimensional vectors describing the counts of the most common categories in 6-month blocks between the ages of 0 to 15. Hierarchical clustering was used to identify subgroups with distinct courses.RESULTS: Four subgroups were identified. The first was characterized by seizures (n = 120, subgroup prevalence 77.5%). The second (n = 197) was characterized by multisystem disorders including gastrointestinal disorders (prevalence 24.3%) and auditory disorders and infections (prevalence 87.8%), and the third was characterized by psychiatric disorders (n = 212, prevalence 33.0%). The last group (n = 4316) could not be further resolved. The prevalence of psychiatric disorders was uncorrelated with seizure activity (P = .17), but a significant correlation existed between gastrointestinal disorders and seizures (P , .001). The correlation results were replicated by using a second sample of 496 individuals from a different geographic region.CONCLUSIONS: Three distinct patterns of medical trajectories were identified by unsupervised clustering of electronic health record diagnoses. These may point to distinct etiologies with different genetic and environmental contributions. Additional clinical and molecular characterizations will be required to further delineate these subgroups.

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“…[7][8][9][10][11][12] Moreover, a higher incidence of different neuropsychiatric disorders, such as autism spectrum, attention deficit hyperactivity disorder, obsessive-compulsive disorders and social behavior problems has been revealed among affected males. [13][14][15][16][17] The impact of DMD on cognitive ability in cognitively healthy populations has not been studied to the best of our knowledge; therefore, in the current study we aim to investigate whether singlenucleotide DMD variants associate with variability in cognitive functions in general populations, suggesting loci in the DMD contributing to cognition, besides genuine DMD variants.…”

Section: Introductionmentioning

confidence: 99%

The dystrophin gene and cognitive function in the general population

et al. 2014

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The aim of our study is to investigate whether single-nucleotide dystrophin gene (DMD) variants associate with variability in cognitive functions in healthy populations. The study included 1240 participants from the Erasmus Rucphen family (ERF) study and 1464 individuals from the Rotterdam Study (RS). The participants whose exomes were sequenced and who were assessed for various cognitive traits were included in the analysis. To determine the association between DMD variants and cognitive ability, linear (mixed) modeling with adjustment for age, sex and education was used. Moreover, Sequence Kernel Association Test (SKAT) was used to test the overall association of the rare genetic variants present in the DMD with cognitive traits. Although no DMD variant surpassed the prespecified significance threshold (Po1 × 10 − 4 ), rs147546024:A4G showed strong association (β = 1.786, P-value = 2.56 × 10 − 4 ) with block-design test in the ERF study, while another variant rs1800273:G4A showed suggestive association (β = − 0.465, P-value = 0.002) with Mini-Mental State Examination test in the RS. Both variants are highly conserved, although rs147546024:A4G is an intronic variant, whereas rs1800273:G4A is a missense variant in the DMD which has a predicted damaging effect on the protein. Further gene-based analysis of DMD revealed suggestive association (P-values = 0.087 and 0.074) with general cognitive ability in both cohorts. In conclusion, both single variant and gene-based analyses suggest the existence of variants in the DMD which may affect cognitive functioning in the general populations.

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The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders

Cited by 488 publications

References 47 publications

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation

Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis

The dystrophin gene and cognitive function in the general population

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