The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population.
Referred youth with autism usually bring six extra psychiatric diagnoses, so broad assessment and multi-target plans are essential.
01Research in Context
What this study did
Joshi et al. (2010) pulled charts from a large U.S. psychiatric clinic. They compared kids with autism to kids without autism who had been sent to the same clinic.
Both groups were already in trouble—families asked for help because something was wrong. The team counted every extra diagnosis each child carried.
What they found
The autism group averaged six extra psychiatric labels each. The non-autism group had far fewer.
Kids with autism also scored lower on daily-living skills and higher on problem behavior checklists.
How this fits with other research
Joshi et al. (2013) later asked the same question in adults and saw the same heavy load, showing the burden lasts past childhood.
Salazar et al. (2015) looked at preschoolers and found nine in ten already had extra disorders. That number feels even higher than the six-label average, but it isn’t a contradiction—Fernando counted any single extra diagnosis while Gagan stacked every diagnosis a older referred child had collected over years.
Guisso et al. (2018) used UK primary-care records and saw lower medication rates than U.S. clinics report. Again, no clash—Gagan studied the sickest end of the spectrum, the kids already sent to psychiatry, while Richard captured everyone with an autism label in a whole country database.
Why it matters
If a family lands in your clinic door with an autism referral, plan for a full battery. Screen for ADHD, anxiety, mood, tics, ODD, and sleep issues right away. Build treatment plans that can hit several targets at once—single-skill programs are not enough when a child carries six diagnoses.
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02At a glance
03Original abstract
The objective of the study was to systematically examine patterns of psychiatric comorbidity in referred youth with autism spectrum disorders (ASD) including autistic disorder and pervasive developmental disorder not otherwise specified. Consecutively referred children and adolescents to a pediatric psychopharmacology program were assessed with structured diagnostic interview and measures of psychosocial functioning. Comparisons were made between those youth satisfying diagnostic criteria for ASD and age and sex matched youth without ASD referred to the same clinical program. 9.3% (217/2323) of the referred youth (age range: 3-17 years) met DSM-III-R criteria for ASD. ASD youth suffered from significantly higher number of comorbid disorders than comparisons (6.4 ± 2.7 vs. 5.2 ± 2.9; p < 0.001). Ninety-five percent of the youth with ASD had three or more comorbid psychiatric disorders and 74% had five or more comorbid disorders. ASD youth were also more functionally impaired and required extra-assistance in school and therapeutic interventions at higher rates than age and sex matched non-ASD referred youth. Youth with ASD have high levels of psychiatric comorbidity and dysfunction comparable to the referred population of youth without ASD. These findings emphasize the heavy burden of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.
Journal of autism and developmental disorders, 2010 · doi:10.1007/s10803-010-0996-9