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Sample Characteristics of the 1,701,206 Adults in the Study Population, All Born From 1967 to 1997 and Followed Until 2015
Source publication
Background:
Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) share common genetic factors but seem to have specific patterns of psychiatric comorbidities. There are few systematic studies on adults; therefore, we compared psychiatric comorbidities in adults with these two neurodevelopmental disorders using populat...
Contexts in source publication
Context 1
... the 1,701,206 individuals included in the study, we identified 38,636 adults (2.3% of the population; 45% women) with ADHD, 7528 adults (0.4%; 27.9% women) with ASD, 1467 adults (0.1%; 28.8% women) with ADHD1ASD, and 1,653,575 adults (97.2%; 49% women) in the remaining population. In 2015, the mean ages of individuals in the ADHD, ASD, and ADHD1ASD groups were 31, 26, and 27 years of age, respectively, compared with 33 years of age in the remaining population (Table 1). Among parents, significantly more mothers of individuals with ASD and ADHD1ASD had the highest level of education compared with the ADHD group and the remaining population, likely explained by the mothers of individuals with ASD/ADHD1ASD having been born later in our study period, in a time during which higher education was more common. ...Context 2
... parents, significantly more mothers of individuals with ASD and ADHD1ASD had the highest level of education compared with the ADHD group and the remaining population, likely explained by the mothers of individuals with ASD/ADHD1ASD having been born later in our study period, in a time during which higher education was more common. In addition, being diagnosed with at least one psychiatric disorder was more prevalent among parents of individuals in all exposure groups, compared with the remaining population (Table 1). ...Citations
... Comorbidity rates of 69 -81% have been reported in adults on the autism spectrum (1,2), with high prevalences of symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), psychotic disorder, substance use disorder (SUD), personality disorders, suicide and self-injury (1)(2)(3)(4)(5)(6)(7)(8)(9). Adults with severe autism symptoms and co-occurring conditions often require prolonged treatment over the life course, involving various treatment modalities in line with existing guidelines (10). ...
Introduction
Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment.
Methods
This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory.
Results
Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
... org/ 10. 1007/ s12264-024-01224-z. hyperactivity disorder (ADHD) not only demonstrated a high level of co-occurrence [4][5][6], but also bore a strong resemblance to clinical characteristics like inattention, social deficits, and anxiety [7][8][9]. Converging evidence suggests that these highly co-occurring symptomatic phenotypes may be mediated by common genetic risk factors [10][11][12][13] and brain dysconnectivity profiles across diagnoses [14][15][16][17][18]. This further extends to other psychiatric disorders like obsessive-compulsive disorder (OCD) which shared inhibitory control deficits and reduced function and structure in the rostral and dorsomedial prefrontal cortex with ASD [18,19], and overlapping social deficits across OCD, ADHD, and ASD [20]. ...
Psychiatric comorbidity is common in symptom-based diagnoses like autism spectrum disorder (ASD), attention/deficit hyper-activity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, these co-occurring symptoms mediated by shared and/or distinct neural mechanisms are difficult to profile at the individual level. Capitalizing on unsupervised machine learning with a hierarchical Bayesian framework, we derived latent disease factors from resting-state functional connectivity data in a hybrid cohort of ASD and ADHD and delineated individual associations with dimensional symptoms based on canonical correlation analysis. Models based on the same factors generalized to previously unseen individuals in a subclinical cohort and one local OCD database with a subset of patients undergoing neurosurgical intervention. Four factors, identified as variably co-expressed in each patient, were significantly correlated with distinct symptom domains ( r = –0.26–0.53, P < 0.05): behavioral regulation (Factor-1), communication (Factor-2), anxiety (Factor-3), adaptive behaviors (Factor-4). Moreover, we demonstrated Factor-1 expressed in patients with OCD and Factor-3 expressed in participants with anxiety, at the degree to which factor expression was significantly predictive of individual symptom scores ( r = 0.18–0.5, P < 0.01). Importantly, peri-intervention changes in Factor-1 of OCD were associated with variable treatment outcomes ( r = 0.39, P < 0.05). Our results indicate that these data-derived latent disease factors quantify individual factor expression to inform dimensional symptom and treatment outcomes across cohorts, which may promote quantitative psychiatric diagnosis and personalized intervention.
... When AQ and ADHD were added in the same regression analysis as predictors, it was seen that there were associations between ADHD traits and all outcome variables except the prosocial variable, whereas AQ only had associations with hyperactivity, peer problems, and prosocial variables. A previous study [30] conducted in Norway found that adults with a dual diagnosis of ADHD and autism were more likely to experience co-occurring mental health disorders, commonly, anxiety disorders. ...
Research on autism and ADHD continues to increase, as does the research on well-being and mental health. There is a growing need to understand what factors impact mental health and well-being, and the question arises as to what factors impact mental health and well-being in autism and ADHD. The existing literature focuses on two different aspects when it comes to the well-being and mental health of autism in students. One aspect focuses on mental health and well-being in diagnosed neurodivergent individuals, and the other aspect focuses on associations between autistic and ADHD traits and mental health and well-being. In order to understand the impact on mental health in autism, an online survey using the Qualtrics platform was given to a sample of 430 university students. The survey used the well-being process questionnaire, the autism spectrum quotient, the ADHD self-report scale, and the strengths and difficulties questionnaire. The results showed significant correlations between anxiety, depression, and autistic and ADHD traits (all correlations > 0.2). These variables were also correlated with the well-being and SDQ outcomes and well-being predictors (all correlations > 0.2). The regression analyses showed significant associations between well-being outcomes and predictor variables and anxiety and depression, whereas the effects of autistic and ADHD traits were restricted to the SDQ outcomes (hyperactivity, conduct, and peer problems). Regression analyses were also conducted to determine whether a variable formed by combining autistic traits, ADHD, anxiety, and depression scores was a significant predictor of well-being and SDQ outcomes. The combined variable was associated with all outcome variables except the prosocial variable. This study provides the basis for further research for understanding the interaction between well-being, mental health, autism, and ADHD.
... Co-occurring intellectual disability is associated with decreased risk for SUD (Butwicka et al., 2017;Santosh & Mijovic, 2006). Co-occurring ADHD, on the other hand, appears to increase the risk of SUD (Butwicka et al., 2017;Ressel et al., 2020;Solberg et al., 2019) and co-occurs very frequently with autism (Ståhlberg et al., 2010;Yule et al., 2023). One other factor associated with AUD for autistic people is age. ...
... Diagnostic criteria may also have affected how clinicians conceptualized the relationship between autism and substance use. While the International Classification of Diseases (ICD) allowed clinicians to diagnose co-occurring autism and ADHD (Solberg et al., 2019;Ståhlberg et al., 2010), only with the advent of the DSM-5 in 2017 were North American clinicians able to do so. Researchers have speculated that clinicians may not have provided accurate autism diagnoses to autistic people who presented with ADHD and substance use due to the mistaken idea that autistic people are not interested in substance use or do not have problems with substance use, which may have further biased research on alcohol use among autistic young people (Butwicka et al., 2017). ...
Purpose
We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years.
Methods
Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0–1 drinking episodes in past year) versus those who drank 2 + times in past year.
Results
Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates.
Conclusion
Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.
... Different studies have indicated that ASD and ADHD have shared and distinct etiologies and manifestations, contributing to their high co-occurrence rate (Antshel and Russo, 2019;Lau-Zhu et al., 2019;Taylor et al., 2015). In this regard, shared genetic factors play a pivotal role (Ghirardi et al., 2019;Solberg et al., 2019). Moreover, common environmental factors might also serve as a less-important underlying cause of this covariation (Pinto et al., 2016); as Taylor et al. demonstrated in a community-based twin study a high genetic overlap between the ADHD traits and social-interacting problems and a mild environmental overlap between different ASD and ADHD domains (Taylor et al., 2015). ...
Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are the two most prevalent neurodevelopmental disorders affecting communication and behavior. The co-occurrence of these conditions is probable and can contribute to several challenges in adaptive functioning and academic achievement.
In this cross-sectional study, 168 Iranian medical students (107 female, 61 male) studying at Tehran University of Medical Sciences in 2021 were enrolled. We administered the Ritvo Autism Asperger Diagnostic Scale–Revised (RAADS-R) and Adult ADHD Self-Report Scale (ASRS) questionnaires online to assess different symptoms of ASD and ADHD in our sample. In this study, the RAADS-R was translated into Persian and validated for the first time in Iran.
The correlation tests demonstrated a significant association between the total score and different subscales' scores of the RAADS-R and the total score and the two subscales' scores of the ASRS questionnaire ( p < 0.001, 0.27 < Spearman correlation coefficient < 0.51). This study also illustrated a high prevalence of ASD and ADHD symptoms among the participants. Moreover, male respondents had a significantly higher prevalence of ASD symptoms (57.3% in males vs . 28.03% in females, p < 0.001).
This study indicated that the distinct impairments in behavior and cognition attributed to ASD and ADHD could be common manifestations in medical students. Given that the co-occurrence of these disorders may lead to significant challenges in their professional life, the early diagnosis and subsequent support for medical students with co-occurring expressions of ASD and ADHD could be extremely helpful, as it could indirectly improve the medical services provided to patients by future physicians, leading to an improvement in public health.
... Recent GWAS evidence showed disorder-specific SNPs for schizophrenia, ASD, and ADHD, but also that most genome-wide significant SNPs had pleiotropic effects [80]. Indeed, CNV pleiotropy is in line with GWAS evidence of considerable genetic overlap between schizophrenia and neurodevelopmental disorders, especially ASD, and ADHD [50,81,82]. Moreover, pairwise common variant meta-analyses of schizophrenia with other psychiatric disorders, including ASD and ADHD, revealed 67 schizophrenia-associated genes shared with other disorders, but also 78 genes not linked to other disorders [83]. ...
Copy number variants (CNVs) are deletions and duplications of DNA sequence. The most frequently studied CNVs, which are described in this review, are recurrent CNVs that occur in the same locations on the genome. These CNVs have been strongly implicated in neurodevelopmental disorders, namely autism spectrum disorder (ASD), intellectual disability (ID), and developmental delay (DD), but also in schizophrenia. More recent work has also shown that CNVs increase risk for other psychiatric disorders, namely, depression, bipolar disorder, and post-traumatic stress disorder. Many of the same CNVs are implicated across all of these disorders, and these neuropsychiatric CNVs are also associated with cognitive ability in the general population, as well as with structural and functional brain alterations. Neuropsychiatric CNVs also show incomplete penetrance, such that carriers do not always develop any psychiatric disorder, and may show only mild symptoms, if any. Variable expressivity, whereby the same CNVs are associated with many different phenotypes of varied severity, also points to highly complex mechanisms underlying disease risk in CNV carriers. Comprehensive and longitudinal phenotyping studies of individual CNVs have provided initial insights into these mechanisms. However, more work is needed to estimate and predict the effect of non-recurrent, ultra-rare CNVs, which also contribute to psychiatric and cognitive outcomes. Moreover, delineating the broader phenotypic landscape of neuropsychiatric CNVs in both clinical and general population cohorts may also offer important mechanistic insights.
... Both autistic women and men in the current study had higher rates of substance use compared to women and men without DD. In population-based studies in Sweden and Norway (Butwicka et al., 2017;Solberg et al., 2019), autistic adults were twice as likely to have substance use problems than non-autistic adults and increased risks were found in non-autistic family members, which may suggest that environmental or genetic factors are at play. Qualitative results have also suggested that autistic adults are more likely to report using substances to manage behavior and/ or mental health difficulties than nonautistic adults, which is particularly problematic given the high rates of co-occurring psychiatric conditions among autistic adults. ...
... Similar to a recent U.S.-based study , patterns of substance use did not differ among our age-matched sample of autistic women and men. In the general population, men are more likely to have substance use disorders than women (McHugh et al., 2018), while mixed patterns have been found in previous samples of autistic women and men (Croen et al., 2015;Roux et al., 2022;Solberg et al., 2019;Weir et al., 2021). Overall, research on substance use among autistic adults is limited and recent research has shown concerningly low rates of substance use education among autistic girls and boys alike (Graham Holmes et al., 2022). ...
This study used administrative data to compare the socio-demographics, health conditions, and health service use of autistic adults with adults with and without other developmental disabilities, after matching for age and sex. Autistic women and men were more likely to have a wide range of physical and mental health conditions compared to adults without developmental disabilities. Rates of co-occurring health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except for a higher prevalence of psychiatric conditions among autistic adults. Notably increased psychiatric service use was evident among autistic women and men compared to the other groups. Among age-matched autistic women and men, significant differences were found for physical (i.e. Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (i.e. psychotic disorders, non-psychotic disorders), as well as service use (i.e. emergency department visits, hospitalizations, family doctor and neurologist visits). These findings suggest autistic adults have high health care needs, as do adults with other developmental disabilities. Mental health support is especially critical for autistic adults and research examining sex and gender effects will assist in tailoring health promotion and intervention efforts.
Lay abstract
This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.
... 46 A Norwegian population study reported that the ASD + ADHD group had higher risk of schizophrenia spectrum disorder than the ASD-alone group. 47 However, another two studies did not find a significant difference in the risk of psychotic disorders between the ASD + ADHD group and the ASDalone group. 46,48 Family history of schizophrenia or ASD The current study found that patients with ASD having a family history of schizophrenia were prone to developing schizophrenia, whereas those with a family history of ASD were not. ...
Aims:
Previous studies have suggested an increased risk of developing schizophrenia later in life in children with ASD. This study aims to investigate the diagnosis stability and the potential predictors for progression to schizophrenia in autism spectrum disorder (ASD).
Methods:
We recruited 11,170 adolescents (10-19 years) and young adults (20-29 years) with ASD between 2001 and 2010. They were followed up to the end of 2011 to identify newly diagnosed schizophrenia. The Kaplan-Meier method and Cox regression with age as a time scale were employed to estimate incidence rates and the significance of candidate predictors.
Results:
The progression rate from ASD to schizophrenia was10.26%for 10 years of follow-up. Among 860 progressors, 580 (67.44%)occurred within the first 3 years after a diagnosis of ASD.The identified predictors were age (reported as hazard ratio with 95% confidence interval: 1.13; 1.11-1.15), depressive disorder (1.36; 1.09-1.69), alcohol use disorder (3.05; 2.14-4.35),substance use disorder (1.91; 1.18-3.09),cluster A personality disorder (2.95; 1.79-4.84), cluster B personality disorder (1.86; 1.05-3.28),and a family history of schizophrenia (2.12; 1.65-2.74).
Conclusion:
More than two-thirds of the progressors developed schizophrenia within the first 3 years. Demographic characteristics, physical and psychiatric comorbidities, and psychiatric family history were significant predictors of progression. This article is protected by copyright. All rights reserved.
... Associations between autistic traits, anxiety and depression have also been found in non-autistic samples (Kanne et al., 2009;Stice & Lavner, 2019) and ADHD trait levels in adults without clinical ADHD diagnoses have been linked to the experience of anxiety and depression (Naya et al., 2021). Furthermore, there is emerging evidence that those who are autistic and have ADHD might be even more likely to experience certain mental health difficulties compared to those who are autistic or have ADHD only (Chen et al., 2015;Gordon-Lipkin et al., 2018;Solberg et al., 2019). For concerns " (p.1405;WHO, 1995). ...
... example, Solberg et al., (2019), using data from Norwegian population-based registries, found higher rates of anxiety in adults who were autistic with additional ADHD, compared to those with either autism or ADHD alone. ...
This study explored whether high autistic traits, high attention deficit hyperactivity disorder (ADHD) traits and their interaction were associated with quality of life (QoL) in a sample of 556 of young-adult twins (Mean age 22 years 5 months, 52% Female). Four participant groups were created: high autistic traits, high ADHD traits, high autistic/ADHD traits, and low ADHD/autistic traits. High autistic traits were associated with lower QoL across domains (physical, psychological, social, and environmental). High ADHD traits associated with lower physical, psychological, and environmental QoL. The interaction of autistic and ADHD traits was not significant in any domain. While mental health difficulties were associated with lower QoL, after accounting for mental health, most relationships between autistic traits, ADHD traits and QoL remained.
... 11.1]) in people with ADHD (Schiweck et al., 2021), while the prevalence of schizophrenia spectrum disorders after ADHD ranged from 0.4% to 6.4% (Nourredine et al., 2021). A large-scale GWAS reported that schizophrenia had stronger genetic correlation with ASD than ADHD, and BD had stronger genetic correlation with ADHD than ASD (Solberg et al., 2019). As a consequence, the etiologies of ASD and schizophrenia might overlap more than ASD and BD, and the etiologies of ADHD and BD might overlap more than ADHD and schizophrenia. ...
... Furthermore, parents of female probands with ADHD-only were associated with the highest likelihood to be diagnosed with BD. An epidemiologic study has reported that the prevalence rate of schizophrenia was higher in women with ASD than in men with ASD (Solberg et al., 2019). Biological studies reported that genetic mutations of schizophrenia (such as 15q33 and 8p12) were associated with female patients with ASD (Chen et al., 2017;Fernandez et al., 2019). ...
Objective
Few studies have investigated the parental risk of major psychiatric disorders among patients with comorbid autism spectrum disorder and attention deficit hyperactivity disorder. This study examined the differences in such risk among patients with autism spectrum disorder–only, with attention deficit hyperactivity disorder–only and both conditions.
Methods
Between 2001 and 2011, we enrolled 132,624 patients with autism spectrum disorder or attention deficit hyperactivity disorder and 1:10 matched controls for age, sex and demographics from the National Health Insurance Database of Taiwan. Poisson regression models were used to examine the risk of five major psychiatric disorders in the patients’ parents compared with those of the controls, including schizophrenia, bipolar disorder, major depressive disorder, alcohol use disorder, and substance use disorder. Patients were classified into the autism spectrum disorder–only, attention deficit hyperactivity disorder–only and dual-diagnosis groups.
Results
The parents of attention deficit hyperactivity disorder–only and dual-diagnosis groups had a higher likelihood to be diagnosed with (odds ratios [95% confidence intervals]) schizophrenia (attention deficit hyperactivity disorder: 1.48 [1.39, 1.57]; dual: 1.79 [1.45, 1.20]), bipolar disorder (attention deficit hyperactivity disorder: 1.91 [1.82, 2.01]; dual: 1.81 [1.51, 2.17]), major depressive disorder (attention deficit hyperactivity disorder: 1.94 [1.89, 2.00]; dual: 1.99 [1.81, 2.20]), alcohol use disorder (attention deficit hyperactivity disorder: 1.39 [1.33, 1.45]; dual: 1.20 [1.01, 1.42]) and substance use disorder (attention deficit hyperactivity disorder: 1.66 [1.59, 1.73]; dual: 1.34 [1.13, 1.58]) than the controls. In contrast, the parents of autism spectrum disorder–only group had a higher likelihood to be diagnosed with schizophrenia (1.77 [1.46, 2.15]) and major depressive disorder (1.45 [1.32, 1.61]) and a lower likelihood to be diagnosed with alcohol use disorder (0.68 [0.55, 0.84]) than the controls.
Conclusion
The autism spectrum disorder–only group had a different parental incidence of major psychiatric disorders than the attention deficit hyperactivity disorder–only and dual-diagnosis groups. Our findings have implications for clinical practice and future genetic research.
