The health status of adults on the autism spectrum
Abstract
Compared to the general pediatric population, children with autism have higher rates of co-occurring medical and psychiatric illnesses, yet very little is known about the general health status of adults with autism. The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the United States. Participants were adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. Autism spectrum disorder cases (N = 1507) were adults with autism spectrum disorder diagnoses (International Classification of Diseases-9-Clinical Modification codes 299.0, 299.8, 299.9) recorded in medical records on at least two separate occasions. Controls (N = 15,070) were adults without any autism spectrum disorder diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age. Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety, bipolar disorder, obsessive–compulsive disorder, schizophrenia, and suicide attempts. Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions, such as stroke and Parkinson’s disease, were also significantly more common among adults with autism. Future research is needed to understand the social, healthcare access, and biological factors underlying these observations.
Get full access to this article
View all access and purchase options for this article.
References
American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: APA.
Anderson DK, Liang JW, Lord C (2014) Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry 55(5): 485–494.
Bauman ML (2010) Medical comorbidities in autism: challenges to diagnosis and treatment. Neurotherapeutics 7(3): 320–327.
Bradley E, Bolton P (2006) Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. The British Journal of Psychiatry 189: 361–366.
Broder-Fingert S, Brazauskas K, Lindgren K, et al. (2014) Prevalence of overweight and obesity in a large clinical sample of children with autism. Academic Pediatrics 14(4): 408–414.
Buck TR, Viskochil J, Farley M, et al. (2014) Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 44: 3063–3071.
Cassidy S, Bradley P, Robinson J, et al. (2014) Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet 1(2): 142–147.
CDC (2014) Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Morbidity and Mortality Weekly Report 63(2): 1–21.
Correll CU (2009) Multiple antipsychotic use associated with metabolic and cardiovascular adverse events in children and adolescents. Evidence-Based Mental Health 12(3): 93.
Crespi B (2011) Autism and cancer risk. Autism Research 4(4): 302–310.
Cross-Disorder Group of the Psychiatric Genomics Consortium (2013) Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet 381(9875): 1371–1379.
Curtin C, Anderson SE, Must A, et al. (2010) The prevalence of obesity in children with autism: a secondary data analysis using nationally representative data from the National Survey of Children’s Health. BMC Pediatrics 10: 11.
Daniels JL, Forssen U, Hultman CM, et al. (2008) Parental psychiatric disorders associated with autism spectrum disorders in the offspring. Pediatrics 121(5): e1357–e1362.
De Bruin EI, Ferdinand RF, Meester S, et al. (2007) High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders 37(5): 877–886.
Denny JC, Ritchie MD, Basford MA, et al. (2010) PheWAS: demonstrating the feasibility of a phenome-wide scan to discover gene-disease associations. Bioinformatics 26(9): 1205–1210.
Eaves LC, Ho HH (2008) Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders 38(4): 739–747.
Ezzati M, Riboli E (2013) Behavioral and dietary risk factors for noncommunicable diseases. The New England Journal of Medicine 369(10): 954–964.
Fein D, Barton M, Eigsti IM, et al. (2013) Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry 54(2): 195–205.
Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N (1998) Comorbidity of Asperger syndrome: a preliminary report. Journal of Intellectual Disability Research 42(Pt 4): 279–283.
Gillott A, Standen PJ (2007) Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disability Research 11(4): 359–370.
Guh DP, Zhang W, Bansback N, et al. (2009) The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9: 88.
Hofvander B, Delorme R, Chaste P, et al. (2009) Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 9: 35.
Joshi G, Petty C, Wozniak J, et al. (2010) The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders 40(11): 1361–1370.
Joshi G, Wozniak J, Petty C, et al. (2013) Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. Journal of Autism and Developmental Disorders 43(6): 1314–1325.
Kanne SM, Christ SE, Reiersen AM (2009) Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders 39(6): 827–833.
Karter AJ, Ferrara A, Liu JY, et al. (2002) Ethnic disparities in diabetic complications in an insured population. The Journal of the American Medical Association 287(19): 2519–2527.
Kohane IS, McMurry A, Weber G, et al. (2012) The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS One 7(4): e33224.
Kral TV, Eriksen WT, Souders MC, et al. (2013) Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: a brief review. Journal of Pediatric Nursing 28(6): 548–556.
Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. American Journal of Public Health 82(5): 703–710.
Levy SE, Giarelli E, Lee LC, et al. (2010) Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental & Behavioral Pediatrics 31(4): 267–275.
Leyfer OT, Folstein SE, Bacalman S, et al. (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders 36(7): 849–861.
Lugnegard T, Hallerback MU, Gillberg C (2011) Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities 32(5): 1910–1917.
McCracken JT, McGough J, Shah B, et al. (2002) Risperidone in children with autism and serious behavioral problems. The New England Journal of Medicine 347(5): 314–321.
Mandell DS (2013) Adults with autism—a new minority. Journal of General Internal Medicine 28(6): 751–752.
Mayes SD, Gorman AA, Hillwig-Garcia J, et al. (2013) Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders 7(1): 109–119.
Morgan NC, Roy M, Nasr A, et al. (2002) A community survey establishing the prevalence rate of autistic disorder in adults with learning disability. Psychiatric Bulletin 26(4): 127–130.
Mouridsen SE, Rich B, Isager T (2008) Psychiatric disorders in adults diagnosed as children with atypical autism. A case control study. Journal of Neural Transmission 115(1): 135–138.
Nicolaidis C, Kripke CC, Raymaker D (2014) Primary care for adults on the autism spectrum. The Medical Clinics of North America 98(5): 1169–1191.
Nicolaidis C, Raymaker D, McDonald K, et al. (2013) Comparison of healthcare experiences in autistic and non-autistic adults: a cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine 28(6): 761–769.
Pan CY, Frey GC (2006) Physical activity patterns in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders 36(5): 597–606.
Paquette-Smith M, Weiss J, Lunsky Y (2014) History of suicide attempts in adults with Asperger syndrome. Crisis 35(4): 273–277.
Raja M, Azzoni A, Frustaci A (2011) AUTISM spectrum disorders and suicidality. Clinical Practice and Epidemiology in Mental Health 7: 97–105.
Russell AJ, Mataix-Cols D, Anson M, et al. (2005) Obsessions and compulsions in Asperger syndrome and high-functioning autism. British Journal of Psychiatry 186: 525–528.
Schieve LA, Gonzalez V, Boulet SL, et al. (2012) Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Research in Developmental Disabilities 33(2): 467–476.
Shea S, Turgay A, Carroll A, et al. (2004) Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 114(5): e634–e641.
Simonoff E, Pickles A, Charman T, et al. (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry 47(8): 921–929.
Sprong M, Becker HE, Schothorst PF, et al. (2008) Pathways to psychosis: a comparison of the pervasive developmental disorder subtype Multiple Complex Developmental Disorder and the “At Risk Mental State.” Schizophrenia Research 99(1–3): 38–47.
Srikanth R, Cassidy G, Joiner C, et al. (2011) Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities. Journal of Intellectual Disability Research 55(1): 53–62.
Stahlberg O, Soderstrom H, Rastam M, et al. (2004) Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. Journal of Neural Transmission 111(7): 891–902.
Sterling L, Dawson G, Estes A, et al. (2008) Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 38(6): 1011–1018.
Storch EA, Sulkowski ML, Nadeau J, et al. (2013) The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders 43(10): 2450–2459.
Thiru K, Hassey A, Sullivan F (2003) Systematic review of scope and quality of electronic patient record data in primary care. British Medical Journal 326(7398): 1070.
Tyler CV, Schramm SC, Karafa M, et al. (2011) Chronic disease risks in young adults with autism spectrum disorder: forewarned is forearmed. American Journal on Intellectual and Developmental Disabilities 116(5): 371–380.
Van de Wouw E, Evenhuis HM, Echteld MA (2012) Prevalence, associated factors and treatment of sleep problems in adults with intellectual disability: a systematic review. Research in Developmental Disabilities 33(4): 1310–1332.
Vannucchi G, Masi G, Toni, et al. (2014) Clinical features, developmental course, and psychiatric comorbidity of adult autism spectrum disorders. CNS Spectrums 19(2): 157–164.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: April 24, 2015
Issue published: October 2015
Keywords
PubMed: 25911091
Authors
Metrics and citations
Metrics
Article usage*
Total views and downloads: 14449
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 668 view articles Opens in new tab
Crossref: 792
- “Why does someone need to have a crisis before anyone will do anything?”: Perspectives of Autism Intensive Support Team staff
- “Bigger lows, but higher highs”: A qualitative exploration of the similarities and differences in quality of life of middle-aged and older autistic and non-autistic adults
- Development of serious mental illness in young adult violent offenders: Early-life risk factors and long-term adverse outcomes
- Emergence and Persistence of Loneliness Among Autistic Adults: A Theoretical Framework
- Protocol for socioecological study of autism, suicide risk, and mental health care: Integrating machine learning and community consultation for suicide prevention
- Pubertal developmental, body mass index, and cardiovascular autonomic function in children and adolescents with and without autism spectrum disorder: a four-time point accelerated longitudinal study
- Atypical Postural Control Variability and Coordination Persist Into Middle and Older Adulthood in Autism Spectrum Disorder
- Barriers and facilitators to primary healthcare encounters as reported by autistic adults: a qualitative study
- Digitale Inklusion von Personen mit Autismus-Spektrum-Störung
- Transcallosal white matter and cortical gray matter variations in autistic adults aged 30–73 years
- View More
Figures and tables
Figures & Media
Tables
View Options
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
I am signed in as:
View my profileSign out
I can access personal subscriptions, purchases, paired institutional access and free tools such as favourite journals, email alerts and saved searches.
loading institutional access options
NAS members can access this journal content using society membership credentials.
NAS members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
