Psychiatric and Medical Challenges in Adults with Autism Spectrum Disorder (ASD) Lawrence Fung, M.D., Ph.D. Autism & Developmental Disabilities Clinic Pediatric Neuropsychopharmacology Clinic Stanford University School of Medicine

Outline Psychiatric co-morbidities in ASD ASD with vs. without intellectual disability Young Adults vs. Middle-aged vs. Elderly with ASD Gender effects Medical co-morbidities Summary

Psychiatric Co-Morbidities in Adults with ASD Author, Year Location # of ASD subjects # of Control subjects Intellectual disability? Age (years) Croen, 2015 Kaisar, USA 1507 15070 (non-ASD) N/A 29±12 Buck, 2014 UT, USA 129 76% with ID 26 to 54 Cervantes, 2015 LS, USA 149 158 (with ID) Yes 51±12 Hofvander, 2009 Sweden 122 No 16 to 60 (median 29) Lugnegard, 2011 54 19±8 Joshi, 2013 MA, USA 63 29±11 Strunz, 2015 Germany 59 106 (TD), 62 (NPD), 80 (BPD) 33±11 Lever, 2016 Netherlands 172 19 to 79 Helles, 2016 50 23±5

Prevalence of Psychiatric Conditions in Adults with ASD and Non-ASD Controls Croen et al. Autism. 2015, Vol. 19(7) 814–823

Anxiety and OCD are Most Common Psychiatric Diagnoses in Adults with ASD+ID. Current Age: 51±12 years Buck et al. J Autism Dev Disord (2014) 44:3063–3071

Depression and Anxiety are Most Common Psychiatric Disorders in High-functioning Adults with ASD

Adults with ASD but without Intellectual Disability have more Psychiatric Diagnoses than other Adults with any Psychiatric Diagnoses. Joshi et al. J Autism Dev Disord (2013) 43:1314–1325

Compared to Young and Middle-aged Adults with HF-ASD, Older Adults with HF-ASD tend to have Fewer Active Co-morbid Psychiatric Problems. Lever et al. J Autism Dev Disord (2016) 46:1916–1930

Variation in prevalence of psychiatric conditions among adults with ASD by gender Croen et al. Autism. 2015, Vol. 19(7) 814–823

MEDICAL CO-MORBIDITIES IN ADULTS WITH ASD

Medical Co-morbidities in Adults with ASD Author, Year Location # of ASD subjects # of Control subjects Intellectual disability? Age (years) Kohane, 2012 MA, USA 14000 N/A 18 to 34 Croen, 2015 Kaisar, USA 1507 15070 (non-ASD) 29±12 Tyler, 2011 OH, USA 108 206 25% ID 29±10 Jones, 2016 UT, USA 92 62% ID 24 to 51 (Median 36)

Epilepsy is a Common Co-morbid Neurologic Disorder in Adults with ASD Croen et al. Autism. 2015, Vol. 19(7) 814–823

GERD is a Common Co-morbid Gastrointestinal Disorder in Adults with ASD Croen et al. Autism. 2015, Vol. 19(7) 814–823

Immune and Sleep Disorders are More Common in Adults with ASD than Controls. Croen et al. Autism. 2015, Vol. 19(7) 814–823

Cardiovascular and Metabolic Disorders are More Common in Adults with ASD than Controls. Croen et al. Autism. 2015, Vol. 19(7) 814–823

Comparison of chronic diseases between adults with ASD and controls in a health care system in Cleveland, OH. Tyler et al. AJIDD. 2011, Vol. 116(5) 371–380

Conclusions Psychiatric Co-morbidities Adults with ASD and intellectual disability Anxiety and OCD are Most Common Psychiatric Diagnoses Adults with high-functioning ASD or Asperger’s disorder Depression and anxiety are most common psychiatric co-morbidities in adults with ASD. Psychiatric problems are less prevalent in older adults with ASD. Medical Co-morbidities Epilepsy is a common co-morbid neurologic disorder in adults with ASD Gastrointestinal (e.g., constipation), immune, sleep, cardiovascular (e.g., hyperlipidemia) and metabolic disorders are more common in adults with ASD

ON-GOING RESEARCH STUDIES

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