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Clinical features, developmental course, and psychiatric comorbidity of adult autism spectrum disorders

  • Giulia Vannucchi (a1), Gabriele Masi (a2), Cristina Toni (a3), Liliana Dell'Osso (a1), Donatella Marazziti (a1) and Giulio Perugi (a1) (a3)...
Abstract

Autism spectrum disorders (ASDs) include a heterogeneous group of neurodevelopmental disorders with early onset in childhood. ASDs should be considered lifelong clinical entities, although there is a certain variability in developmental trajectories, and therefore should be considered of great interest also for adulthood psychiatrists. A few studies have been carried out to explore the clinical picture and course development of these disorders during adulthood, or their relationship with other mental disorders. Indeed, ASDs often share overlapping features with other disorders, such as schizophrenia and obsessive-compulsive, mood, and personality disorders, and as a result misdiagnoses often occur. The aim of this review is to summarize the available literature on ASDs in adulthood with a specific focus on the clinical picture, course, and psychiatric comorbidity. It is proposed that a careful diagnostic screening for ASDs in adults would contribute to clarifying the relationship with comorbid psychiatric disorders, while improving the possibility of treatment and outcome of such conditions.

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Corresponding author
*Address for correspondence: Dr. Giulio Perugi, Clinica Psichiatrica Università di Pisa, Via Roma, 67, 56100, Pisa, Italy. (Email: giulio.perugi@med.unipi.it)
References
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1. Bleuler, E. Dementia Praecox oder Gruppe der Schizophrenien. In: Aschaffenburg GE, ed. Handbuch der Psychiatrie. Leipzig, Germany: Deuticke; 1911.
2. Kanner, L. Autistic disturbances of affective contact. Nervous Child. 1943; 2: 217250.
3. Asperger, H. Die autistischen Psychopathen im Kindersalter. Arch Psychiatr Nervenkr. 1944; 117: 76136.
4. Volkmar, FR, Cohen, DJ. Debate and argument: the utility of the term pervasive developmental disorder. J Child Psychol Psychiatry. 1991; 32(7): 11711172.
5. Newschaffer, CJ, Falb, MD, Gurney, JG. National autism prevalence trends from United States special education data. Pediatrics. 2005; 115(3): e277e282.
6. Billstedt, E, Gillberg, IC, Gillberg, C. Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. J Child Psychol Psychiatry. 2007; 48(11): 11021110.
7. Howlin, P, Goode, S, Hutton, J, Rutter, M. Adult outcome for children with autism. J Child Psychol Psychiatry. 2004; 45(2): 212229.
8. Shattuck, PT, Seltzer, MM, Greenberg, JS, etal. Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. J Autism Dev Disord. 2007; 37(9): 17351747.
9. Lai, MC, Lombardo, MV, Pasco, G, etal. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS One. 2011; 6(6): e20835.
10. Kobayashi, R, Murata, T. Setback phenomenon in autism and long-term prognosis. Acta Psychiatr Scand. 1998; 98(4): 296303.
11. Taylor, JL, Seltzer, MM. Changes in the autism behavioral phenotype during the transition to adulthood. J Autism Dev Disord. 2010; 40(12): 14311446.
12. Bishop, SL, Richler, J, Lord, C. Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychol. 2006; 12(4–5): 247267.
13. Seltzer, MM, Shattuck, P, Abbeduto, L, Greenberg, JS. Trajectory of development in adolescents and adults with autism. Ment Retard Dev Disabil Res Rev. 2004; 10(4): 234247.
14. Esbensen, AJ, Seltzer, MM, Lam, KS, Bodfish, JW. Age-related differences in restricted repetitive behaviors in autism spectrum disorders. J Autism Dev Disord. 2009; 39(1): 5766.
15. Hoekstra, RA, Bartels, M, Verweij, CJ, Boomsma, DI. Heritability of autistic traits in the general population. Arch Pediatr Adolesc Med. 2007; 161(4): 372377.
16. Whitehouse, AJ, Coon, H, Miller, J, Salisbury, B, Bishop, DV. Narrowing the broader autism phenotype: a study using the Communication Checklist—Adult Version (CC-A). Autism. 2010; 14(6): 559574.
17. Attwood, T, ed. The Pattern of Abilities and Development of Girls with Asperger's Syndrome: Asperger's and Girls. Arlington, TX: Future Horisons, Inc.; 2006.
18. Gillberg, C, ed. A Guide to Asperger Syndrome. Cambridge, UK: Cambridge University Press; 2002.
19. Roy, M, Dillo, W, Emrich, HM, Ohlmeier, MD. Asperger's syndrome in adulthood. Dtsch Arztebl Int. 2009; 106(5): 5964.
20. Bakken, TL, Helverschou, SB, Eilertsen, DE, Heggelund, T, Myrbakk, E, Martinsen, H. Psychiatric disorders in adolescents and adults with autism and intellectual disability: a representative study in one county in Norway. Res Dev Disabil. 2010; 31(6): 16691677.
21. Clarke, D, Baxter, M, Perry, D, Prasher, V. The diagnosis of affective and psychotic disorders in adults with autism: seven case reports. Autism. 1999; 3: 149164.
22. Ghazziuddin, M, Zafar, S. Psychiatric comorbidity of adults with autism spectrum disorders. Clinical Neuropsychiatry. 2008; 5(1): 912.
23. Dossetor, DR. “All that glitters is not gold”: misdiagnosis of psychosis in pervasive developmental disorders—a case series. Clin Child Psychol Psychiatry. 2007; 12(4): 537548.
24. Hutton, J, Goode, S, Murphy, M, Le Couteur, A, Rutter, M. New-onset psychiatric disorders in individuals with autism. Autism. 2008; 12(4): 373390.
25. Cooper, SA, Smiley, E, Morrison, J, etal. Psychosis and adults with intellectual disabilities: prevalence, incidence, and related factors. Soc Psychiatry Psychiatr Epidemiol. 2007; 42(7): 530536.
26. Tsiouris, JA, Kim, SY, Brown, WT, Cohen, IL. Association of aggressive behaviours with psychiatric disorders, age, sex and degree of intellectual disability: a large-scale survey. J Intellect Disabil Res. 2011; 55(7): 636649.
27. Mouridsen, SE, Rich, B, Isager, T. Psychiatric disorders in adults diagnosed as children with atypical autism: a case control study. J Neural Transm. 2008; 115(1): 135138.
28. Konstantareas, MM, Hewitt, T. Autistic disorder and schizophrenia: diagnostic overlaps. J Autism Dev Disord. 2001; 31(1): 1928.
29. Ghaziuddin, M. A family history study of Asperger syndrome. J Autism Dev Disord. 2005; 35(2): 177182.
30. Nylander, L, Gillberg, C. Screening for autism spectrum disorders in adult psychiatric out-patients: a preliminary report. Acta Psychiatr Scand. 2001; 103(6): 428434.
31. Sheitman, BB, Kraus, JE, Bodfish, JW, Carmel, H. Are the negative symptoms of schizophrenia consistent with an autistic spectrum illness? Schizophr Res. 2004; 69(1): 119120.
32. Goldstein, G, Minshew, NJ, Allen, DN, Seaton, BE. High-functioning autism and schizophrenia: a comparison of an early and late onset neurodevelopmental disorder. Arch Clin Neuropsychol. 2002; 17(5): 461475.
33. Rinehart, NJ, Bradshaw, JL, Brereton, AV, Tonge, BJ. Movement preparation in high-functioning autism and Asperger disorder: a serial choice reaction time task involving motor reprogramming. J Autism Dev Disord. 2001; 31(1): 7988.
34. Mayes, SD, Calhoun, SL. Ability profiles in children with autism: influence of age and IQ. Autism. 2003; 7(1): 6580.
35. Bagner, DM, Melinder, MR, Barch, DM. Language comprehension and working memory language comprehension and working memory deficits in patients with schizophrenia. Schizophr Res. 2003; 60(2–3): 299309.
36. Bellack, AS, Morrison, RL, Wixted, JT, Mueser, KT. An analysis of social competence in schizophrenia. Br J Psychiatry. 1990; 156(6): 809818.
37. Barneveld, PS, Pieterse, J, de Sonneville, L, etal. Overlap of autistic and schizotypal traits in adolescents with autism spectrum disorders. Schizophr Res. 2011; 126(1–3): 231236.
38. Esterberg, ML, Trotman, HD, Brasfield, JL, Compton, MT, Walker, EF. Childhood and current autistic features in adolescents with schizotypal personality disorder. Schizophr Res. 2008; 104(1–3): 265273.
39. Rutter, M. Autistic children: infancy to adulthood. Semin Psychiatry. 1970; 2(4): 435450.
40. Lainhart, JE. Psychiatric problems in individuals with autism, their parents, and siblings. Int Rev Psychiatry. 1999; 11(4): 278298.
41. Perry, DW, Marston, GM, Hinder, SA, Munden, AC, Roy, A. The phenomenology of depressive illness in people with a learning disability and autism. Autism. 2001; 5(3): 265275.
42. de Bruin, EI, Ferdinand, RF, Meester, S, de Nijs, PF, Verheij, F. High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord. 2007; 37(5): 877886.
43. Ghaziuddin, M, Ghazziuddin, N, Greden, J. Depression in adults with autism: implications for research and clinical care. J Autism Dev Disord. 2002; 32: 299306.
44. Munesue, T, Ono, Y, Mutoh, K, etal. High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: a preliminary study of 44 outpatients. J Affect Disord. 2008; 111(2–3): 170175.
45. Bolton, PF, Pickles, A, Murphy, M, Rutter, M. Autism, affective and other psychiatric disorders: patterns of familial aggregation. Psychol Med. 1998; 28(2): 385395.
46. Ghaziuddin, M, Greden, J. Depression in children with autism/pervasive developmental disorders: a case-control family history study. J Autism Dev Disord. 1998; 28(2): 111115.
47. Piven, J, Palmer, P. Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. Am J Psychiatry. 1999; 156(4): 557563.
48. Sterling, L, Dawson, G, Estes, A, Greenson, J. Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. J Autism Dev Disord. 2008; 38(6): 10111018.
49. Raja, M, Azzoni, A. Comorbidity of Asperger's syndrome and bipolar disorder. Clin Pract Epidemiol Ment Health. 2008; 4: 26.
50. McElroy, SL. Diagnosing and treating comorbid (complicated) bipolar disorder. J Clin Psychiatry. 2004; 65(Suppl 15): 3544.
51. Stahlberg, O, Soderstrom, H, Rastam, M, Gillberg, C. Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. J Neural Transm. 2004; 111(7): 891902.
52. Kerbeshian, J, Burd, L. Case study: comorbidity among Tourette's syndrome, autistic disorder, and bipolar disorder. J Am Acad Child Adolesc Psychiatry. 1996; 35(5): 681685.
53. Tantam, D. Asperger syndrome in adulthood. In: Frith U, ed. Autism and Asperger Syndrome. Cambridge, UK: Cambridge University Press; 1991: 147183.
54. Lugnegard, T, Hallerback, MU, Gillberg, C. Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Res Dev Disabil. 2011; 32(5): 19101917.
55. DeLong, GR, Dwyer, JT. Correlation of family history with specific autistic subgroups: Asperger's syndrome and bipolar affective disease. J Autism Dev Disord. 1988; 18(4): 593600.
56. Gillberg, IC, Gillberg, C. Asperger syndrome—some epidemiological considerations: a research note. J Child Psychol Psychiatry. 1989; 30(4): 631638.
57. DeLong, R. Children with autism spectrum disorder and a family history of affective disorder. Dev Med Child Neurol. 1994; 36(8): 674687.
58. Mattila, ML, Hurtig, T, Haapsamo, H, etal. Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study. J Autism Dev Disord. 2010; 40(9): 10801093.
59. Leyfer, OT, Folstein, SE, Bacalman, S, etal. Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord. 2006; 36(7): 849861.
60. Ivarsson, T, Melin, K. Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD). J Anxiety Disord. 2008; 22(6): 969978.
61. Bejerot, S, Nylander, L, Lindstrom, E. Autistic traits in obsessive-compulsive disorder. Nord J Psychiatry. 2001; 55(3): 169176.
62. Russell, AJ, Mataix-Cols, D, Anson, M, Murphy, DG. Obsessions and compulsions in Asperger syndrome and high-functioning autism. Br J Psychiatry. 2005; 186(6): 525528.
63. McDougle, CJ, Kresch, LE, Goodman, WK, etal. A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry. 1995; 152(5): 772777.
64. Hollander, E, King, A, Delaney, K, Smith, CJ, Silverman, JM. Obsessive-compulsive behaviors in parents of multiplex autism families. Psychiatry Res. 2003; 117(1): 1116.
65. Abramson, RK, Ravan, SA, Wright, HH, etal. The relationship between restrictive and repetitive behaviors in individuals with autism and obsessive compulsive symptoms in parents. Child Psychiatry Hum Dev. 2005; 36(2): 155165.
66. Sverd, J. Tourette syndrome and autistic disorder: a significant relationship. Am J Med Genet. 1991; 39(2): 173179.
67. Kano, Y, Ohta, M, Nagai, Y, Yokota, K, Shimizu, Y. Tourette's disorder coupled with infantile autism: a prospective study of two boys. Jpn J Psychiatry Neurol. 1988; 42(1): 4957.
68. Miller, JN, Ozonoff, S. Did Asperger's cases have Asperger disorder? A research note. J Child Psychol Psychiatry. 1997; 38(2): 247251.
69. Tantam, D. Lifelong eccentricity and social isolation. II: Asperger's syndrome or schizoid personality disorder? Br J Psychiatry. Dec 1988; 153(6): 783791.
70. Hurst, RM, Nelson-Gray, RO, Mitchell, JT, Kwapil, TR. The relationship of Asperger's characteristics and schizotypal personality traits in a non-clinical adult sample. J Autism Dev Disord. 2007; 37(9): 17111720.
71. Lugnegard, T, Hallerback, MU, Gillberg, C. Personality disorders and autism spectrum disorders: what are the connections? Compr Psychiatry. 2012; 53(4): 333340.
72. Sucksmith, E, Roth, I, Hoekstra, RA. Autistic traits below the clinical threshold: re-examining the broader autism phenotype in the 21st century. Neuropsychol Rev. 2011; 21(4): 360389.
73. Dawson, G, Estes, A, Munson, J, etal. Quantitative assessment of autism symptom-related traits in probands and parents: Broader Phenotype Autism Symptom Scale. J Autism Dev Disord. 2007; 37(3): 523536.
74. Losh, M, Childress, D, Lam, K, Piven, J. Defining key features of the broad autism phenotype: a comparison across parents of multiple- and single-incidence autism families. Am J Med Genet B Neuropsychiatr Genet. 2008; 147B(4): 424433.
75. Smith, CJ, Lang, CM, Kryzak, L, etal. Familial associations of intense preoccupations, an empirical factor of the restricted, repetitive behaviors and interests domain of autism. J Child Psychol Psychiatry. 2009; 50(8): 982990.
76. Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J, Clubley, E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001; 31(1): 517.
77. Constantino, JN, Lajonchere, C, Lutz, M, etal. Autistic social impairment in the siblings of children with pervasive developmental disorders. Am J Psychiatry. 2006; 163(2): 294296.
78. McDougle, CJ, Scahill, L, McCracken, JT, etal. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network: background and rationale for an initial controlled study of risperidone. Child Adolesc Psychiatr Clin N Am. 2000; 9(1): 201224.
79. Zuddas, A, Zanni, R, Usala, T. Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies. Eur Neuropsychopharmacol. 2011; 21(8): 600620.
80. Hollander, E, Dolgoff-Kaspar, R, Cartwright, C, Rawitt, R, Novotny, S. An open trial of divalproex sodium in autism spectrum disorders. J Clin Psychiatry. 2001; 62(7): 530534.
81. Piven, J, Chase, GA, Landa, R, etal. Psychiatric disorders in the parents of autistic individuals. J Am Acad Child Adolesc Psychiatry. 1991; 30(3): 471478.
82. Kerbeshian, J, Burd, L, Fisher, W. Lithium carbonate in the treatment of two patients with infantile autism and atypical bipolar symptomatology. J Clin Psychopharmacol. 1987; 7(6): 401405.
83. Tantam, D, Girgis, S. Recognition and treatment of Asperger syndrome in the community. Br Med Bull. 2009; 89(1): 4162.
84. Henry, CA, Steingard, R, Venter, J, etal. Treatment outcome and outcome associations in children with pervasive developmental disorders treated with selective serotonin reuptake inhibitors: a chart review. J Child Adolesc Psychopharmacol. 2006; 16(1–2): 187195.
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CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
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