A Review of Cases Presenting with Symptoms of Autism Spectrum Disorder At An Outpatient Mental Health Program

Background: Autism Spectrum Disorders (ASDs) are associated with increased rates of comorbid psychiatric disorders including depression, anxiety disorders, and obsessive compulsive disorder (Matson & Nebel-Schwalm, 2007).  In a recent study of comorbid psychiatric disorders, 70% of individuals with ASD had at least one comorbid disorder and 41% had two or more (Simonoff, 2008). In some cases, comorbid psychiatric disorders may interfere with or delay the recognition of an ASD. While the average age of an ASD diagnosis is approximately 5.7 years of age (Shattuck et al., 2009), factors such as the presence of comorbid psychiatric diagnoses can delay the diagnosis of ASD (Shattuck & Grosse, 2007). The characteristics of individuals who receive psychiatric diagnoses before receiving ASD diagnoses are currently unclear. Both non-recognition and misdiagnosis are likely to significantly impair treatment of individuals with ASD (Fraser et al., 2011).

Objectives: The goal of the current study is to identify and describe a group of children and youth with existing learning and/or psychiatric diagnoses who were referred for an ASD assessment. These children and youth were seen by psychiatrists and allied mental health professionals  (e.g., social workers) at an outpatient mental health program for a range of presenting problems before being referred for an ASD assessment.

Methods: The files of six individuals referred for an ASD assessment were reviewed to gain a better understanding of the characteristics of this group. Files were reviewed for existing learning and/or psychiatric diagnoses, scores on standardized assessment measures of ASD symptoms, age of onset of ASD symptoms, and history of involvement of mental health services. The standardized assessment measures of ASD symptoms included the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994), the Autism Diagnostic Observation Schedule; Lord et al., 2000; and the Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003).

Results: The majority of individuals referred for an ASD assessment met criteria for an ASD diagnosis. The characteristics of individuals who met criteria for an ASD, as well as those who were referred for an assessment and did not meet criteria, will be described.

Conclusions: Describing this group of children and youth using standardized, gold standard diagnostic measures (e.g., Nachshen et al., 2008), will lead to a better understanding of individuals with ASD with comorbid learning and/or psychiatric diagnoses. This, in turn, will lead to earlier and more accurate diagnosis and treatment for this diagnostically complex group of individuals.