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Open Access Highly Accessed Research article

Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders

Björn Hofvander1*, Richard Delorme27, Pauline Chaste27, Agneta Nydén3, Elisabet Wentz34, Ola Ståhlberg5, Evelyn Herbrecht267, Astrid Stopin2, Henrik Anckarsäter125, Christopher Gillberg3, Maria Råstam8 and Marion Leboyer2679

Author Affiliations

1 Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden

2 INSERM, U 995, dept of Genetics, Institut Mondor de Recherche Biomédicale, Psychiatry Genetics, Creteil, France

3 Child and Adolescent Psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

4 Vårdal Institute, Swedish Institute for Health Sciences, Lund, Sweden

5 Forensic Psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

6 Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier Hospitals, Department of Psychiatry, Creteil, France

7 Fondation FondaMental, Creteil, France

8 Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden

9 University Paris 12, Faculty of Medicine, IFR10, Creteil, France

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BMC Psychiatry 2009, 9:35  doi:10.1186/1471-244X-9-35

Published: 10 June 2009

Abstract

Background

Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs.

Methods

Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians.

Results

Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects.

Conclusion

ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.