Mental Health Aspects of Autistic Spectrum Disorders

Background: autism spectrum disorders (ASD) classified as pervasive developmental disorders in ICD-10 and DSM-IV, occur along a broad continuum of severity with impairments in social interactions, communication and behaviour. For the person with the condition the cause of mental health difficulties is quite often put down to the autism and in the relatives it is attributed to the stress of living with a person with autism. However co-morbid psychiatric diagnoses can complicate the management of individuals with autism and accurate, reliable diagnosis of co-morbidities is of major importance. When problematic behaviours are recognized as manifestations of a co-morbid psychiatric disorder, more specific treatment is possible.

Objectives: to  examine patterns of co-morbid and associated psychiatric problems in children with ASD and their parents.

Methods: Inclusion criteria for the study are diagnosis of autism based on the Autism Diagnostic Interview-Revised (ADI-R), a diagnosis of autism or autism spectrum disorder based on the Autism Diagnostic Observational Schedule (ADOS) and IQ or score greater than 35. Participants were recruited through Child and Adolescent Mental Health Clinics, Specialist Autism Clinics, Special Schools, Advocacy groups and individual clinician referral. In addition to the ADI-R and ADOS the Child Behavior Checklist (CBCL) and the Brief Symptom Inventory (BSI) were administered.  The CBCL for ages 6-18 was used to obtain standardized parents' reports of children's social competencies and behavioral/emotional problems. Parents reported their own current level of psychological distress using the BSI.

Results: So far data has been collected from 72 parents of children age range 8–17. The mean IQ score was 75 and the mean age was 12.6 years; 88% were male. Results of the CBCL revealed that majority of parents reported their child as having either internalizing (clinical range: 72.4%; borderline range: 21.4%) or externalizing problems (clinical range: 19.2%; borderline range: 17.1%). Clinically significant difficulties were detected for the ADHD CBCL DSM orientated subscale. Borderline clinically significant means were detected for CBCL anxiety and affective DSM orientated subscales. Parental mean age was 50.1 years. The presence of BSI T-scores greater than 63 on two or more subscales indicates possible psychopathology. Based on this criterion 29% of fathers and 32.5% were diagnosable with psychopathology, obsessive-compulsive and interpersonal sensitivity being most common. Based on BSI Global Severity Index 31% of fathers and 24% of mothers produced scores that were sufficiently severe to suggest a diagnosis of psychopathology. The BSI indices didn’t significantly correlate neither with CBCL internalising nor with externalising scores.

Conclusions:

1.      The majority of children diagnosed with autism had some internalizing problems and reached clinically significant levels on ADHD CBCL DSM orientated subscale. 

2.      Based on BSI up to one third of parents were diagnosable with psychopathology, Obsessive-Compulsive and Interpersonal Sensitivity being most common. .

3.   Based on an absence of correlation between BSI scores and CBCL scores it could be postulated that parental psychological distress wasn’t significantly associated neither with externalizing nor with internalising problems in their children and did not influence the reporting of symptoms in the children.