As the Autism Spectrum Disorders (ASD) are being better recognized and identified, both in early childhood and even in later childhood and adolescence, this is leading to better awareness of the impact of autism on some of our adult patients. As we know, ASD is a lifetime condition. Patients with ASD are at higher risk for other mental health concerns as well. This article will touch on some of those risks in adult patients with ASD.
Generally speaking, people with developmental disabilities, including ASD, are at greater risk than the general population to have co-morbid mental health concerns. For a variety of reasons, they also have a more challenging time accessing appropriate behavioral health services. These reasons include: there exists a division between behavioral health and developmental services; many adult medical and mental health providers are not comfortable working with persons with developmental disabilities, many persons with developmental disabilities are nonverbal and have intellectual disabilities, making it hard to assess for psychiatric symptoms. This makes it important for primary care providers to be aware of this risk of co-morbidity to help patients and families access important care.
When compared to the general population, persons with ASD are at higher risk for some mental health concerns and are at equal risk for other mental health concerns. The rate of depression and/or suicidal thoughts in adults with ASD is 25% compared to 7% for the general population. Adults with ASD are more susceptible to depression than their siblings without ASD. The rate of anxiety and obsessive-compulsive disorder (OCD) in adults with ASD is 40% compared to 15% for the general population. The rate of ADHD and disruptive behaviors in children with ASD is 50% compared to 6% of the general population. Adults with ASD have the same rate of bipolar disorder, schizophrenia, and substance abuse disorders as the general population.
It is often thought that when an adult with ASD presents with mood or behavioral symptoms, that it is just “part of the Autism” and does not represent a separate mental health disorder. How does one tell if the symptoms go above and beyond what is expected for Autism? For example, it is common for adults with ASD to be rigid and have repetitive behaviors and become upset if there is a change in routine. A provider should consider an additional diagnosis of OCD if there is evidence of obsessional worries that are about non-preferred topics and that the patient does not like that leads to compulsions to try to get rid of or avoid the worry.
Less impacted individuals are particularly susceptible to co-morbid anxiety and depressive disorders. A recent study found that young adults with ASD without an accompanying intellectual disability were more likely to have co-morbid depression than young adults with ASD with intellectual disability. It is thought that they are more aware than more impacted individuals of their differences compared to typically developing peers. This can lead to a feeling of being “different” and low self-esteem. There can also be sadness and feelings of worthlessness if a less impacted adult is having a hard time achieving life goals in terms of education, occupation and relationships. There can be sadness and resentment about having challenges establishing independence from one’s family of origin.
A specialist who is familiar with both conditions can be helpful. It is challenging to find behavioral health specialists who work with adults but who have some training in child development and developmental disabilities. This is definitely an area of need.
It is our hope that this primer helps improve awareness for primary care providers on the increased risk of mental health concerns in adults with ASD, particularly ones with no intellectual disability.