International Meeting for Autism Research: Psychiatric Symptoms and Comorbidities in Children with a History of Autism Who Achieve An “Optimal Outcome”

Friday, May 21, 2010

Franklin Hall B Level 4 (Philadelphia Marriott Downtown)

3:00 PM

K. E. Tyson , Department of Psychology, University of Connecticut, Storrs, CT

E. Troyb , Department of Psychology, University of Connecticut, Storrs, CT

M. A. Rosenthal , Department of Psychology, University of Connecticut, Storrs, CT

M. Helt , Psychology, University of Connecticut, Storrs, CT

I. M. Eigsti , Psychology, University of Connecticut, Storrs, CT

M. L. Barton , Department of Psychology, University of Connecticut, Storrs, CT

L. Naigles , Department of Psychology, University of Connecticut, Storrs, CT

E. A. Kelley , Psychology, Queen's University, Kingston, ON, Canada

A. Orinstein , Department of Psychology, University of Connecticut, Storrs, CT

M. C. Stevens , Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital / Yale University, Hartford, CT

R. T. Schultz , Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA

D. A. Fein , Department of Psychology, University of Connecticut, Storrs, CT

Background: A study is currently following children who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder. These children have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of children, once diagnosed with ASD, achieve an "optimal outcome" (Sutera et al., 2007, Kelley et al., 2006, and Helt et al., 2008).

Objectives: The current study examines the lifetime prevalence of psychiatric disorders (other than ASD) in these “optimal outcome” (OO) children as compared to typically developing (TD) children and children with high-functioning autism (HFA). The study also looks at the occurrence of psychiatric symptoms in these children, whether or not these symptoms are part of a full-fledged diagnosis.

Methods: We compared prevalence rates of psychiatric symptoms and disorders in 19 TD children (mean age = 13.5), 20 HFA children (mean age = 12.8), and 28 OO children (mean age = 13.0). Groups did not differ in gender (p = .42), age (p = .77), or WASI full-scale IQ (p = .35). We administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) to children’s parents to ascertain current and lifetime rates of at-threshold psychiatric symptoms, as well as of specific disorders, across the three groups. Only lifetime rates are examined in the present study.

The K-SADS-PL asks whether a child has any broad symptoms of a psychiatric disorder before proceeding to more fine-grained questions about the disorder. Non-parametric Fisher’s Exact tests assessed differences across groups in lifetime presence of psychiatric symptoms and diagnoses.

Results: There were differences among the three groups in the frequency of at least one lifetime symptom of several disorders. Compared to TD children, the OO children showed greater frequency of at least one lifetime symptom of ADHD (p<.01), ODD (p<.01), or specific phobia (p<.01). Significantly more HFA than TD children showed at least one lifetime symptom of ADHD (p<.001), social phobia (p<.001), or depression (p<.01). In addition, significantly more HFA than OO children evidenced at least one lifetime symptom of generalized anxiety disorder (p<.001); there was no such difference between the HFA and TD groups.

Frequencies of lifetime psychiatric diagnoses, as determined by the K-SADS-PL supplementary interviews, were also analyzed. Significantly more OO than TD children met criteria for a lifetime diagnosis of ADHD (p<.001) or specific phobia (p<.01). Furthermore, significantly more HFA than TD children met criteria for a lifetime diagnosis of ADHD (p<.001). Compared to OO children, more HFA children also met criteria for a lifetime diagnosis of ODD (p<.01).

Conclusions: Although the OO children in this study appear to have experienced less lifetime psychopathology than the HFA group, the OO children displayed significantly more lifetime psychiatric symptoms and comorbid diagnoses than TD children. These findings suggest that these OO children, though evidencing fewer lifetime symptoms than HFA children, may retain or develop certain psychiatric symptoms after losing an ASD diagnosis.

See more of: Comorbidities
See more of: Clinical & Genetic Studies