INSAR RECAP: Medical and Psychiatric Co-Occurring Conditions in Autism

We just returned from the 2019 International Society for Autism Research (INSAR) conference, the world’s largest autism research conference. This week we are sharing some of the research that we came across. Today we cover presentations from two sessions that we attended on medical and psychiatric co-occurring conditions in autistic individuals.

What does the research tell us?

Anxiety is one of the most common co-occurring conditions, with up to 80% of autistic young people experiencing symptoms of anxiety. Casey Burrows (University of Miami) found that the association between autism and anxiety symptoms is seen across a range of ages, ability levels and genders. She also explained how restricted and repetitive behaviours (a core feature of autism) are negatively associated with anxiety, suggesting that these actions either mask anxiety symptoms, or hopefully lead to a reduction in anxiety.

Suqian Duan (McPartland Lab; Yale School of Medicine) reported on the influence of depressive symptoms on adaptive functioning (skills needed for everyday living) in autistic children. She found that the more depressed autistic children are, the lower they score in adaptive functioning tasks (particularly relating to socialisation). Duan calls for further research to investigate the relationship process between depressive symptoms and social functioning.

Kate Gotham (Vanderbilt University Medical Centre) showed that mood, in particular depression, explains responses to emotional information better than autistic traits. Also, non-autistic people with depression show elevated scores on the ADOS (an assessment often used to help diagnose autism), suggesting that mood may obscure autism diagnosis.

Some initial research by Audrey Blakeley-Smith (University of Colorado) suggests that group cognitive behavioural therapy for autistic adolescents with intellectual disability, may improve anxiety and other mood concerns in this group. They highlight the need to assess this intervention for children and adults too.  

Amy Barrett (University of California Santa Barbara) reported on the increased likelihood of Adverse Childhood Experiences (ACES) in families with autistic children. These were more likely in families with increased parental stress, financial strain, isolation, and lack of social support. She found that autistic children show elevated levels of post-traumatic stress symptoms, as well as higher self-injury behaviours. She acknowledged that more research into the relationship between social behaviours and mental health problems is needed.

Paul Lipkin (Kennedy Krieger Institute) highlighted the need for research on co-occurring mental health conditions and suicidal behaviours in autism. He explained that parents of autistic children (aged between 8-25 years) report high rates of suicidal thought and behaviour, including plans to and attempts to die by suicide.

Caitlin Conner reported that suicidal ideation (SI; thinking about dying by suicide) is higher in autistic people. In addition, difficulties in regulating emotions is associated with higher reported SI in autistic. It therefore appears that emotion dysregulation is a risk factor for suicidality in autism.

Next steps

Panel members suggested that researchers should study co-occurring conditions in autism, and make better use of self-report measures (rather and/or in addition to parental or caregiver reports).

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