A transdiagnostic model of psychiatric symptom co-occurrence and autism spectrum disorder.
Mental-health symptoms in autistic kids mostly follow the same factor structure as in typical kids—except ADHD and social anxiety are genuinely more common and deserve first-line attention.
01Research in Context
What this study did
Rodriguez-Seijas et al. (2020) asked if the way mental-health symptoms cluster in autistic kids is the same as in typical kids.
They ran a factor analysis on symptom checklists from a mixed-age group with and without ASD.
The goal was to see whether the same broad "transdiagnostic" factors fit both groups.
What they found
The same three-factor structure—internalizing, externalizing, and a general thought/attention factor—fit both autistic and non-autistic youth.
Only two symptoms were truly higher in ASD: ADHD and social anxiety.
All other co-occurring problems followed the same pattern seen in typical kids.
How this fits with other research
Rosello et al. (2022) looked at 34 studies and found that kids with both ASD and ADHD have tougher cognitive, adaptive, and emotional profiles than kids with either label alone.
That sounds like a contradiction, but it isn’t: Craig shows ADHD is uniquely elevated in ASD, while Rocio shows the combo is especially impairing.
Dellapiazza et al. (2021) and Fombonne et al. (2021) extend the same point—ASD+ADHD brings more social impairment and higher rates of anxiety and depression, backing Craig’s call to flag these two conditions first.
Georgiades et al. (2011) and Lecavalier et al. (2011) did similar factor work in preschoolers and also found that standard psychiatric dimensions hold up in ASD, so Craig’s pattern now extends down to early childhood.
Why it matters
When an autistic client shows mood or behavior symptoms, start by asking if ADHD or social anxiety is in the mix. These two drive the biggest share of added impairment. Use the same transdiagnostic checklists you already know; they work. Targeting ADHD attention breaks and social-anxiety exposures can give you more bang for your treatment buck than hunting for exotic "autism-only" problems.
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02At a glance
03Original abstract
Understanding whether the co-occurrence of psychiatric symptoms within autism spectrum disorder (ASD) are specific to the ASD diagnosis or reflect similar higher-order patterns observed in both ASD and non-ASD samples, or a confluence of the two, is of critical importance. If similar, it would suggest that comorbid psychiatric conditions among individuals with ASD are not symptoms of specific, non-ASD psychiatric disorders per se, but reflect a general liability to psychopathology associated with ASD. To this end, the current study examined whether the higher-order structure of co-occurring psychiatric symptoms was the same within ASD and non-ASD youth. Parents of clinic-referred youth with (n = 280) and without (n = 943) ASD completed a DSM-IV-referenced psychiatric symptom rating scale. A confirmatory factor analytic framework was used to examine four levels of measurement invariance across groups to determine the extent to which transdiagnostic factors were comparable. Transdiagnostic factors were characterized by symptoms of the same disorders (configural invariance) and the same factor loadings across groups (metric invariance). Furthermore, both groups evidenced equivalent numbers of symptoms of most psychiatric conditions with the notable exceptions of attention deficit hyperactivity disorder (ADHD) and social anxiety (partial strong invariance), which were higher in the ASD sample. It was concluded that disparities in the co-occurrence of psychiatric symptoms between youth with and without ASD may be largely reflective of transdiagnostic factor level differences associated with ASD and not indicative of the ASD diagnosis per se. However, for ADHD and social anxiety, there appears to be some specific associations with the ASD diagnosis. Autism Res 2020, 13: 579-590. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Few transdiagnostic dimensions relate common mental disorder diagnoses with one another. These dimensions explain psychiatric comorbidity (i.e., the finding that many persons possess several disorder diagnoses simultaneously). However, it is unclear if these dimensions differ among children with autism spectrum disorder (ASD), compared with their non-ASD counterparts. The results of this study demonstrate that underlying transdiagnostic dimensions are similar in both ASD and non-ASD children. However, there appear to be ASD-specific differences when it comes to social anxiety and attention deficit hyperactivity disorder.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2228