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News

Adults with autism are at risk for host of health problems

by  /  16 May 2015

Disease burden: Medical issues ranging from obesity to depression often accompany autism in adulthood.

©iStock.com/Jim DeLillo

Adults with autism are at an increased risk for diabetes, depression and a number of other health problems, according to a large survey of electronic health records published 24 April in Autism1.

“The prevalence of co-occurring medical and psychiatric conditions is very high in adults with autism in pretty much every category across the board,” says lead researcher Lisa Croen, director of the Autism Research Program at Kaiser Permanente in Oakland, California.

The number of adults on the spectrum is rising. The U.S. Centers for Disease Control and Prevention estimated in 2010 that 1 in 68 children have autism, up from 1 in 150 just eight years before. So these health problems will affect a growing slice of society. “This is a major public health issue and will only be exacerbated by the aging of our western populations,” says Joseph Piven, professor of psychiatry at the University of North Carolina at Chapel Hill, who was not involved with the study.

Croen and her team reviewed the medical records of 1,507 adults with autism aged 18 or older and 15,070 adults without the disorder. Of the individuals with autism, 143 are 50 years or older. The study is the first large-scale look at a range of medical conditions in adults with autism above 35 years of age.

The health complications that accompany autism, according to the study, include immune disorders such as allergies or asthma; metabolic disorders such as diabetes; heart disease; and motor disorders such as cerebral palsy. Intriguingly, adults with autism do not have an increased risk of cancer, despite some genetic overlap between the conditions.

Some of these health problems may be tied to symptoms of the disorder. For instance, people with autism are 1.4 times more likely to be obese and about 3 times more likely to have constipation. Obesity could be related to picky eating, which stems from restricted interests, a feature of autism. But it is also a common side effect of drugs used to allay autism symptoms, says Edwin Cook, professor of psychiatry at the University of Illinois at Chicago.

Some of the most striking increases in risk are for other psychiatric disorders. Women with autism are 46 times more likely to have schizophrenia and men with autism 17 times more likely, compared with their counterparts who do not have autism. This gender difference may be due to the fact that doctors associate autism with men and are more likely to mistakenly deem women who have autism as having schizophrenia.

What’s more, a diagnosis of both schizophrenia and autism is likely to be a mistake, says Cook. He says he knows adults who have been misdiagnosed with psychosis simply because they behaved unusually.

On the other hand, clinicians may be missing signs of severe depression in men and women with autism. Adults with autism are three times as likely to be depressed and five times as likely to attempt suicide as other adults. Yet of the 27 people in the study who attempted suicide, only 14 had been diagnosed with depression.

Other conditions that affect adults with autism may reflect a lack of preventative medical care. These include diabetes and high blood pressure — which are twice as likely to occur in adults with autism — and heart disease, which is more than twice as common, compared with controls.

Going to the doctor can be stressful for people with autism, says Croen. She plans to comb the records for clues that adults with autism use the healthcare system differently than do other adults. People with autism may be wary of preventative exams such as colonoscopies, for example, and may not find it easy to graduate from pediatricians to doctors who treat adults.

“We want to develop tools and resources that could improve that transition,” she says.

References:

1. Croen L.A. et al. Autism Epub ahead of print (2015) PubMed

 


  • Paul Whiteley

    This is important work. Very important work.

    Not only from the point of view of medical comorbidity (some might say a sense of adult ‘ESSENCE’) but also with regards to screening and appropriate management strategies being implemented save any charges of further health inequality appearing.

    Outside of anxiety (an ‘intolerance of uncertainty’ perhaps?) the depression-bipolar link is particularly important given the possible ‘atypical’ presentation that might be encountered when autism is present:

    Bipolar disorder in adults with Asperger׳s Syndrome: a systematic review: http://www.ncbi.nlm.nih.gov/pubmed/25046741

    Insofar as the schizophrenia link and the possibility of a return to once forgotten times, I’m also minded to link to an interesting post previously on this blog from Uta Frith and the important work from Mildred Creak and colleagues:

    The Nine Points (Mildred Creak and Working Party, 1961): http://sfari.org/news-and-opinion/blog/2014/the-nine-points-mildred-creak-and-working-party-1961

    Bottom line: (1) a diagnosis of autism is seemingly protective of nothing when it comes to comorbidity, (2) the ESSENCE of autism can change as maturation continues: see also Helles et al: http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12334/abstract and (3) regular preferential health screening is a strong requirement for autism in both childhood and adulthood.

    Thanks for the post.

  • Nick

    I can understand having other mental issues (such as OCD, Schizophrenia, or Anxiety), but there’s a lack of a “why” mentioned in this article in regards to the physical health issues.

    Certainly, if a person is overweight, there’s a risk of things like high blood pressure, heart disease, and possibly diabetes…but that has nothing to do with autism, as not every adult with autism is overweight.

    I can also understand that having these disorders puts a lot of stress on a person with it (I’m on the spectrum, so I know that for a fact), and stress can cause various physical manifestations such as GI issues and increased anxiety.

    So, then, my question is:
    WHY do adults with autism have a higher chance of developing these health issues?

    What is it about autism (and the other mental disorders mentioned) which increases the risk of health issues?

    Looking at the tags for the article, I can guess that it depends if the person is overweight or not, but not all people on the spectrum are overweight.
    So, then, does the study this article presents only apply to those who are overweight? And if so, what does having autism have to do with it? There are people who have health risks due to obesity who are not on the spectrum, after all.

  • jwright

    Hi Nick,
    Thanks so much for your comment. The researchers are still not clear on the reasons why, but are pursuing it.

    One reason may be that some of these things are caused by the same underlying genetics that lead to autism. This may be the case for gut problems, for example, as they’re so common across people in the disorder. They could also be a byproduct of symptoms.

    Another possibility is that adults with autism don’t receive the same level of preventative health care as other adults. In follow up work, the researchers surveyed primary care doctors and found that they’re ill-equipped to help adults with autism.

    http://sfari.org/news-and-opinion/conference-news/2015/international-meeting-for-autism-research-2015/primary-care-doctors-unprepared-to-help-adults-with-autism

    One last thing worth noting is that a 2-fold increased risk, for example, may sound high. But if the condition is rare to begin with, it may not be as big a concern as it sounds.

    I hope this helps!
    Thank you for your careful reading of SFARI.org.
    Jessica

  • Michelle

    A lot of these studies confuse correlation and causation. Poverty in general correlates to a number of these, and if you spent your life being rejected, stepped on, and blamed for it, you’d be a smidge depressed too.

  • Planet Autism

    There are apparently higher rates of schizophrenia in autism than in the typical population. But also there are some superficially similar traits and years ago many autistic people were misdiagnosed with schizophrenia, medicated and locked away sadly. I am even more convinced having read the above that research findings saying schizophrenia is more prevalent in autism should be rechecked because of the potential for error.

    Autism was once termed childhood schizophrenia. The issues lie with e.g. (it might be Attwood who has described this scenario) an autistic person being asked if they hear voices by a clinician, and the autistic being literal will say “yes” because they hear peoples’ voices but they are not hearing voices in their head. So it’s important that things an autistic child would say are not misconstrued as potentially schizophrenic, but yes, the conditions can co-exist.

  • Planet Autism

    I would also state that for at least some conditions (and most certainly auto immune ones such as hay fever and eczema) there is a link precisely because autism is related to the immune system. There needs to be more research on the exact link between autism and methylation, Ehlers Danlos syndrome is related to autism and there are methylation issues connected with that too. Dots need joining up!

  • Planet Autism

    Finally, obesity and the associated health problems that come with that, including diabetes, could well be linked to the fact that some with autism isolate themselves and choose sedentary pastimes such as using computers and aren’t going out being active due to fear, social phobia, harassment etc. As Michelle says, correlation and causation are being confused, it’s potentially a simplistic view when it comes to some of the health issues.

  • Rachel

    The graph (double Jeopardy), is strange…where did the research come from for this? It appears to me that this article is still trying to pin Point Autism as a mental disorder, G:I illnesses score low, why? Almost all people with ASD and Aspberger have G.I issues. The Medical research papers are out there…you just need to find them, and read them.

  • Shree

    Highly appreciate for your work with the mind that it may give the true result.
    Thank you.

  • Seth Bittker

    I agree with many of the commentators who have observed that autism typically features abnormalities of biochemistry that are unhealthy which means higher comorbidity with other diseases.

    In a presentation I gave at IMFAR I provided a table with a list of some of the features of this dysfunctional biochemistry. It is available here: https://autismvitamind.files.wordpress.com/2015/05/table-1-may-11.pdf

  • anonymous

    I was officially diagnosed at almost 46. when I was a kid they called it learning disabilities.

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