Opinion Conversations on the science of autism research.

Multiple diagnoses

by  /  6 May 2010


Autism is a complex spectrum of disorders, and it’s not at all uncommon for children with the disorder to have other psychiatric problems: attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, anxiety and mood disorders, among others.

In fact, 95 percent of these children have at least three other psychiatric disorders, and 74 percent have five or more, according to a study in the Journal of Autism and Developmental Disorders.

More than 80 percent of kids with autism have ADHD, making it the most common co-diagnosis; 61 percent have two or more anxiety disorders — notably, agoraphobia — and 56 percent have major depression.

The data are based on 2,323 children who sought psychiatric care at a large medical center between 1991 and 2008. The children were all referred to the clinic for emotional or behavioral difficulties, and not for any specific disorder.

Given their multiple burdens, it’s no wonder children with autism have more trouble functioning typically: According to the study, they are more likely to be in a special education class, to repeat a grade and to receive a combination of drugs and counseling compared with controls.

Diagnosing the full spectrum of these children’s psychiatric problems could make a big difference to their treatment. For instance, the only two drugs approved for autism — risperidone and aripiprazole —treat irritability and aggression, which are more likely to occur in a child who has several disorders.

4 responses to “Multiple diagnoses”

  1. Anonymous says:

    Isn’t this a situation open to selection bias?

    Here is the statement from the abstract:

    “Consecutively referred children and adolescents to a pediatric psychopharmacology program were assessed with structured diagnostic interview and measures of psychosocial functioning.”

    They are monitoring children who required medication, not a general sampling of autistic children.

    One can not state that 95% of autistic children have 3 or more diagnoses. 95% of those seeking pharmacological treatment, yes.

  2. Aphid says:

    It is easy to conflate autistic behaviors with behaviors associated with other disorders. The repetitive behaviors of an autistic child can be mistaken for OCD. The unfocused behaviors of an autistic child experiencing sensory overload can be mistaken for ADHD. The non-compliant behaviors of an autistic child taking language literally can be mistaken for ODD. Clinicans need to systemize and apply autistic theory of mind before they deluge autistic children with unnecessary labels and medications.

  3. Virginia Hughes says:

    Sullivan, you’re absolutely right — they only looked at kids getting treated at their center, and this pattern wouldn’t necessary be found in the broader population of individuals with autism.

    Aphid, I agree this is a really difficult problem. I find your comment especially interesting in light of one left by another reader on another post. In Sue’s opinion, it’s the “secondary” issues that researchers should be focusing on:


    Thanks for reading SFARI.

  4. Bob says:

    Did these kids get the autism vaccination should be the real question. We have an epidemic on our hands. What changed???

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