Behavioral addiction and autism spectrum disorder: A systematic review.
The autism–addiction link looks shaky, so probe for other mental-health issues before treating ‘autistic fixation’ as addiction.
01Research in Context
What this study did
Lo et al. (2021) looked at every paper they could find on behavioral addictions in people with autism.
They pulled 30 studies and checked if autism raises the odds of problems like gambling, gaming, or social-media over-use.
The team graded the quality of each study to see how much trust we can place in the numbers.
What they found
Most studies pointed toward a link, but the evidence was weak and messy.
Samples were small, measures differed, and few studies used control groups.
Bottom line: we still cannot say for sure that autism alone drives behavioral addictions.
How this fits with other research
Ressel et al. (2020) covered the same ground for drug and alcohol abuse. They also found wide, shaky prevalence numbers. Together the two reviews warn us: addiction rates in autism are all over the map.
Bouck et al. (2016) offered the same take-home in an earlier narrative review. The story has not changed—research quality is still too thin to guide practice.
Gitimoghaddam et al. (2022) show the flip side: we have hundreds of ABA outcome studies, yet almost none watch for gaming, gambling, or pornography problems. We measure language and IQ but skip addictive behaviors.
Why it matters
When a client with autism spends hours gaming or can’t stop online shopping, don’t assume autism is the cause. Screen for anxiety, ADHD, and depression first. Add addiction questions to your intake forms and track screen time like you track tantrums. We need data before we can treat what we think we see.
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02At a glance
03Original abstract
BACKGROUND: According to DSM-5 criteria, Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficiencies in social communication and interaction along with the presence of restrictive and repetitive patterns of behavior. Few studies have explored the prevalence of behavioral addiction in individuals with ASD. Since addiction and ASD share common characteristics, individuals with ASD may be more vulnerable to addictive behaviors. Some typical behavioral addictions include internet, gaming, and gambling addiction. While most previous studies on ASD and addiction have looked at chemical addiction, behavioral addiction has not been thoroughly studied to date. AIMS: The objective of this study was to investigate the presence of behavioral addiction among individuals diagnosed with autism spectrum disorder. METHODS AND PROCEDURES: A systematic literature search of five databases was conducted in accordance with the PRISMA guidelines. Search results were reviewed for the predetermined inclusion criteria independently by two authors. OUTCOMES AND RESULTS: The search yielded 539 publications after the removal of duplicates. 61 met the inclusion criteria for title and abstract review. Full texts were reviewed resulting in an additional 31 being removed. The remaining 30 included 4 case reports and 26 original studies. Results included 27 studies that found a positive correlation (15 of significance, 12 of unknown significance) between a behavioral addiction and either ASD or Autistic traits, 1 found a significant negative correlation, 3 did not find a correlation. CONCLUSIONS AND IMPLICATIONS: This review is inconclusive about links between ASD and behavioral addictions. While a vast majority of studies show a positive correlation, many do not provide the statistical analysis to show if the correlations are significant. In addition, a positive correlation between ASD and behavioral addiction is observed in the presence of comorbid mental health conditions in many of the studies. Further research with proper controls and statistical analysis is needed to determine whether the development of behavioral addiction is directly influenced by ASD or if the presence of a comorbid mental health condition is the true cause.
Research in developmental disabilities, 2021 · doi:10.1016/j.ridd.2021.104033