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Comorbid Medical Conditions in a Population-Based Sample of Adults with ASD

Friday, 3 May 2013: 16:45
Chamber Hall (Kursaal Centre)
W. M. McMahon1, A. V. Bakian2, J. Viskochil3, H. Coon2, M. Farley2, E. L. Botts4 and D. Bilder2, (1)Psychiatry, University of Utah, Salt Lake City, UT, (2)University of Utah, Salt Lake City, UT, (3)Utah Autism Research Program, Salt Lake City, UT, (4)Department of Psychiatry, Vanderbilt University, Nashville, TN
Background: Understanding the presence of co-morbid medical disorders has important implications for our understanding of adult outcomes and medical care for individuals with autism spectrum disorders (ASD). Several studies have found high rates of co-morbid medical conditions among children and adults with ASD even when compared to individuals with other developmental disabilities.  Common conditions include seizures, sleep disturbance, obesity, gastrointestinal symptoms, and endocrine abnormalities.  Unfortunately, the frequencies of these conditions or symptoms have not yet been established in a representative sample of adults.  Thus, a detailed assessment of current and chronic medical symptoms and conditions provides an important contribution to our understanding of adult outcomes associated with ASD. 

Objectives: This study examines adults with ASD to (1) determine the presence of co-morbid medical symptoms and disorders and (2) identify the patterns of medical symptoms and disorders affecting this population-based adult ASD sample.   

Methods: As part of a large adult outcomes study, individuals with ASD (and their caregivers) ascertained during a 1980’s state-wide Utah autism epidemiological study reported their medical history and current complaints during a medical review of systems interview.  This interview followed a standard medical review of systems approach querying common medical complaints.  Further elaboration was obtained for medical conditions which were perceived by the individual and/or caregiver as problematic and/or necessitated intervention.  This interview was administered to 82 participants with either DSM III autism [N= 62 (75.3%)] identified in the original study or DSM-IV-TR autism spectrum disorder [N= 20 (24.4%)], identified during a reclassification study.  Assessments with caregivers on an additional 10 individuals who were deceased at the time of the follow-up study were also performed. 

Results: Assessments were completed on 92 individuals (69 male, 23 female, median age among living participants was 36.1 years, age range 27 to 54, 21 participants had an IQ >69).  Median BMI among all individuals was 25.8 with a range of 13.6-59.4.  Weight categories were: 13 (19.4%) underweight (BMI<20); 12 (17.9%) normal (BMI 20-25); 17 (25%) overweight (BMI, 25.1-29.9), and 25 (37%) obese (BMI>30).  Genetic disorders were present in 13 (14%) of participants (6, 60% of deceased),17 (18%) individuals were taking medication for at least one chronic medical condition, and 23 (25%) were hospitalized at least once for a life-threatening medical condition.  On review of systems, individuals most commonly experienced neurologic (66, 71.7%) and gastrointestinal (53, 57%) symptoms. The most common specific conditions were constipation [N= 33 (36%)], frequent ear infections [N=34 (37%)], seizures [N=43 (47%)] and sleep disorders [N= 42 (46%)]. The most prominent discrepancy between living and deceased participants was the presence of seizures which occurred in 35 (43%) of living and 8 (80%) of deceased participants. 

Conclusions: Our findings are consistent with previous reports in regards to high rates of elevated BMI, sleep disturbance, epilepsy, and constipation.  Chronic medical conditions affecting the adult ASD population necessitate ongoing access to primary care and disease management.  Further analyses are underway to examine the patterns of medication use and the clustering of common symptoms across medical conditions in this population.

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