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Alcohol Use Patterns Among Underage Autistic and Non-Autistic Youth. J Autism Dev Disord 2023:10.1007/s10803-023-06086-4. [PMID: 37751088 DOI: 10.1007/s10803-023-06086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/27/2023]
Abstract
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.
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A Manualized Behavioral Therapy Intervention for Youth with Autism Spectrum Disorder and Substance Use Disorder. Case Rep Psychiatry 2023; 2023:8998160. [PMID: 37038552 PMCID: PMC10082677 DOI: 10.1155/2023/8998160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Research highlights the increasing overlap of autism spectrum disorder and substance use disorders in young people. However, no behavioral treatments exist addressing this comorbidity despite great need. A team of clinicians developed an integrated behavioral protocol addressing substance use in youth with autism spectrum disorder. The multidisciplinary team developed 12 youth, 7 parent, and 3 joint modules based on established evidence-based therapies shown to have effectiveness separately addressing autism spectrum and substance use. Two cases are discussed to illuminate this integrated intervention. Adaptations to the protocol were made during feedback from patients and their parents. Further research is needed to determine the effectiveness of this preliminary protocol.
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Reasons for alcohol use and non-use by underage U.S. autistic youth: A qualitative study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:213-225. [PMID: 35499489 PMCID: PMC9626389 DOI: 10.1177/13623613221091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT What is already known about the topic? Hazardous alcohol use is when a person's drinking puts them at increased risk for negative events (e.g. health problems or car crashes). Some studies show that autistic people may be at greater risk for hazardous alcohol use than non-autistic people, while other studies have found that hazardous alcohol use is less common among autistic people than non-autistic people. We need to learn why autistic underage youth choose to drink alcohol or not. The goal of this study was to learn from US autistic youth about their attitudes and behavior related to alcohol. Forty autistic youth aged 16-20 years old were interviewed.What this article adds? Youth described several reasons why they choose to drink alcohol, including feeling like non-autistic people are more accepting when drinking, that it puts them in a less irritable or bored mood, helps them cope with problems, and helps them fit in. Reasons for not drinking alcohol include worries about becoming addicted, medication interactions, not liking the taste, fear of experiencing hangover and other health problems, and concern about acting foolish when drunk.Implications for practice, research, or policy Results reveal that hazardous alcohol use in autistic adults could have its roots in underage experiences that give autistic youth temporary relief from social anxiety, feeling lonely, and challenges with sensory processing. Right now, there are no evidence-based alcohol prevention programs in the United States for autistic people. One or more such programs may be needed. The results from this study could be used to adapt existing programs for non-autistic youth to the unique needs and risk factors of autistic youth.
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Adapting Drug and Alcohol Therapies for Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:214-223. [PMID: 36606157 PMCID: PMC9645670 DOI: 10.1089/aut.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Autistic people may be at a higher risk of drug and alcohol misuse than the general population. Autistic people, however, are under-represented within drug and alcohol support services. This is the first survey of drug and alcohol therapists' perceptions of current service provision for autistic clients and recommendations for reasonable adjustments that therapists can make to enhance successful outcomes. Methods We conducted an online survey of 122 drug and alcohol therapists, exploring therapists' demographics, training and experience with autistic clients, approaches and adaptations used with autistic clients, and therapists' confidence with autistic clients. Within two focus groups, 11 members of the autistic and broader autism (e.g., family members, professionals) communities reflected on the reasonable adjustments reported by therapists. Results Most therapists had autistic clients and most therapists had received no autism-specific training. Alcohol misuse was the most common presenting issue, and most therapists reported that treatment outcomes were less favorable for autistic clients than for other groups. Therapists perceived that barriers to successful outcomes were (1) a lack of autism-specific training, (2) a need to adapt therapy for autistic clients, and (3) a lack of shared perspective between the therapist and the autistic client. Previous research has identified a range of reasonable adaptations and, when asked, therapists were moderately confident in their ability to deliver these. Members of the autistic and broader autism communities coproduced guidance detailing how therapists can best adapt their practice for autistic clients including how to structure sessions and the language to use within sessions. Conclusion This study highlights a need for practical and theoretical training for drug and alcohol therapists to support successful adaptation to current service provision for autistic clients and to develop a shared perspective on the desired aims and outcomes of the therapeutic process.
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A national profile of substance use disorder among Medicaid enrollees on the autism spectrum or with intellectual disability. Disabil Health J 2022; 15:101289. [DOI: 10.1016/j.dhjo.2022.101289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
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Characterizing autistic traits in treatment-seeking young adults with substance use disorders. Am J Addict 2021; 31:108-114. [PMID: 34957636 DOI: 10.1111/ajad.13247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/04/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent work highlights an increase in the overlap of autism spectrum disorder (ASD) and substance use disorder (SUD). Little is known about the presence of ASD symptoms in SUD-treatment-seeking populations. METHODS The informant-rated Social Responsiveness Scale-2 (SRS-2) was completed at intake to an outpatient SUD clinic for youth aged 16-26 (N = 69). Comparisons were made between those with elevated SRS-2 scores on demographic, psychiatric, and substance use variables. RESULTS Parents of sixty-nine patients with SUD completed the SRS-2. Fourteen (20%) (average age 18.7 ± 2.5) had elevated SRS-2 Total T-scores (≥66) and 55 (average age 18.1 ± 2.8) had non-clinical SRS-2 Total T-scores. There were few differences between groups; however, those with elevated SRS-2 Total T-scores were more likely to have a stimulant use disorder (odds ratio [OR] = 7.59, 95% confidence interval [CI] = 0.77, 101.88; p = 0.05) or an opioid use disorder (OR = 5.02, 95% CI = 0.59, 43.27; p = 0.08) than patients with normal SRS-2 Total T-scores as well as alcohol use in the week prior to intake. DISCUSSION AND CONCLUSIONS A significant proportion of treatment-seeking SUD outpatients suffer from clinically elevated autistic traits. These findings highlight the importance of assessing for autistic traits in SUD treatment settings yet additional research is needed to determine if these findings are specific to the presence of ASD or secondary to sequelae of specific SUD presentations. SCIENTIFIC SIGNIFICANCE This study is, to our knowledge, the first to have examined the prevalence, morbidity, or clinical characteristics, associated with ASD symptoms in a SUD-specific population.
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A Systematic Literature Review on the Relationship Between Autism Spectrum Disorder and Substance Use Among Adults and Adolescents. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00242-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Low prevalence of risk drinking in adolescents and young adults with autism spectrum problems. Addict Behav 2021; 113:106671. [PMID: 33080544 DOI: 10.1016/j.addbeh.2020.106671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) have high rates of "comorbidity". Research on concurrent substance use (disorder) in ASD, however, is scarce and findings have been inconsistent. This study aims at assessing the prevalence of risk drinking in adolescent and young adult twins with and without autism spectrum problems. Data from a Swedish longitudinal nationwide twin study were analyzed. Across three age groups of 15- (N = 10,050), 18- (N = 7,931) and 24-year-olds (N = 2,882) prevalence rates of risk drinking were compared between twins with and without an ASD proxy diagnosis and between different ASD subgroups based on comorbid proxies for attention-deficit/hyperactivity disorder (ADHD) and/or Learning Disorder (LD). ASD, ADHD, and LD were assessed using the Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC), and risk drinking was captured by the Alcohol Use Disorders Identification Test (AUDIT; age 18 and 24) and another set of self-report questions (age 15). In each age group, the prevalence of risk drinking in ASD was lower than in individuals without ASD, yet increasing continuously with age. Exploratory subgroup ASD analyses showed a trend towards risk drinking being more common among individuals with co-existing ADHD or LD problems than among those without "comorbidity", although sample sizes were too small to draw any certain conclusions. This study indicates low prevalence of risk drinking in adolescents and young adults with autism spectrum problems and highlights the need for further research on alcohol use in individuals with ASD and comorbid disorders.
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The Expectancies and Motivations for Heavy Episodic Drinking of Alcohol in Autistic Adults. AUTISM IN ADULTHOOD 2020; 2:317-324. [PMID: 36600957 PMCID: PMC8992867 DOI: 10.1089/aut.2020.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background For autistic adults, the perceived benefits of drinking alcohol to facilitate social interaction may be particularly appealing. Alcohol may be considered "self-medication" for clinical features of autism or may be used to help cope with elevated levels of co-occurring anxiety. Methods We developed an online survey and 507 autistic adults responded to questions concerning their expectancies and motivations for heavy episodic drinking. The survey also included questions about ways of seeking support, if needed, and barriers to seeking support. Results Over half of those who had drunk alcohol reported heavy episodic drinking in the past year (6 or more units of alcohol at one time). Heavy episodic drinkers endorsed traditional expectancies (e.g., "Alcohol generally has powerful positive effects on people") and autism-specific expectancies (e.g., "Alcohol makes verbal communication easier") to a greater degree than nonheavy episodic drinkers. Autism-specific expectancies, not traditional expectancies, related to frequency of drinking. The strongest motivations for heavy episodic drinking were for social reasons and to enhance positive feelings, rather than for conformity or coping. If support was required for problematic drinking, the internet was the most commonly chosen resource, although 45% of the participants indicated that they would not seek support. Perceived barriers to support included concern that it would take place in an unfamiliar chaotic environment and concern about being misunderstood and judged by a therapist. Conclusions This study is the first to identify the expectancies and motivations for heavy episodic drinking in autistic adults as well as identifying barriers to seeking support. There may be some autism-specific expectancies related to the nature of autism that impact upon heavy episodic drinking, as well as impacting upon seeking support. The autistic and broader autism communities can benefit from an awareness of these findings, and service providers can adapt support appropriately. Lay summary Why was this study done?: Little is known about how alcohol is used within the autistic community. One population-based study found that autistic adults were four times more likely to experience problematic drinking compared with nonautistic adults.What was the purpose of this study?: This study identified the expectations and motivations for heavy episodic-or "binge"-drinking alcohol among autistic adults. Binge drinking is a risk factor for problematic drinking. The study also identified how autistic adults accessed support should it be needed, and what the potential barriers were to accessing support.What did the researchers do?: We conducted an online survey with 507 autistic adults with formal or informal diagnoses of autism. The survey asked about the frequency of drinking alcohol and binge drinking. Participants then answered a questionnaire about why they drank alcohol. The questions asked about general reasons for drinking (such as: "Alcohol generally has powerful positive effects on people [e.g., makes you feel good or happy; future seems brighter]") as well as autism-related reasons (such as: "Alcohol makes verbal communication easier [e.g., starting conversations, responding to what other people say, or maintaining a normal back-and-forth conversation]"). Finally, participants answered questions about seeking help and potential barriers to help-seeking.What were the results of the study?: Binge drinkers reported a greater number of traditional and autism-relevant expectations for drinking alcohol than nonbinge drinkers. The strongest motivations for drinking alcohol were for social reasons and to enhance positive feelings, rather than coping or to conform. The internet was the most common source of support for problematic drinking (49% of participants); however, 45% of participants indicated that they would not seek any support. Perceived barriers to support were an unfamiliar chaotic environment and being misunderstood and judged by a therapist. Around one fifth of participants self-diagnosed themselves with autism, rather than having a formal diagnosis from a clinician. These two groups were very similar to each other.What do these findings add to what was already known?: This is the first study to identify the expectations and motivations for binge drinking alcohol in the autistic community.What are potential weaknesses in the study?: This was an online survey, and the diagnostic status of participants cannot be verified. Participants chose to take part in the study, and this may represent a bias as some people may not want to take part in online surveys or may not have access to the internet, or may not be part of networks that send out invitations to take part in research. In addition, the sample was largely female and well educated, which is not reflective of the autistic population as a whole.How will these findings help autistic adults now or in the future?: Better understanding the expectations and motivations for binge drinking alcohol can help inform support that is targeted at the autistic community. Alcohol support services can be better informed about how to adapt their provision for the autistic community specifically.
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The Critical Lack of Data on Alcohol and Marijuana Use by Adolescents on the Autism Spectrum. AUTISM IN ADULTHOOD 2020; 2:282-288. [PMID: 36600961 PMCID: PMC8992854 DOI: 10.1089/aut.2019.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Emerging evidence suggests that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, U.S. population-based estimates of substance use by autistic youth are limited. The aim of this perspective article was to highlight the lack of data sets that collect information about alcohol and marijuana use by autistic youth in the United States. We used a four-step investigation to identify potential data sources that could provide an estimate of the prevalence of alcohol and/or marijuana use in autistic youth, without regard to whether those estimates would be robust. We identified a total of 19 potential U.S. data sources. Of these, only one included information about both autism and alcohol and/or marijuana by youth. There is too little research on substance use by autistic adolescents, and rigorously collected data would benefit the field. Our recommendations include increased federal funding for data collection from autistic youth on substance use, additional questions on nationally representative surveys that assess autism status in multiple ways, and the use of robust measures of substance use that allow for characterization of substance use according to multiple dimensions. As the number of autistic youth identified increases and these youth transition into adulthood, better understanding of their substance use patterns is critical for developing health promotion efforts that appropriately and fully serve the needs of autistic youth. Lay summary Why is this topic important?: Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Previous studies suggest that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, estimates of substance use by autistic youth in the United States are limited.What is the purpose of this article?: This study was performed to highlight the lack of data sets that collect information about alcohol and/or marijuana use by autistic youth in the United States. We systematically reviewed U.S. data sources on child and/or adolescent health, disability, and/or substance use to identify sources that could generate estimates of the prevalence of substance use among autistic adolescents in the United States, even if those estimates may not be stable due to small sample sizes or other methodological weaknesses.What is the perspective of the authors?: The authors are a team of allistic researchers. M.B.-M. and S.B.-F. are pediatricians. E.F.R. and A.A. are public health researchers. S.B.-F. has an extensive background in providing clinical health care services to children with autism and is an autism researcher. R.A.N.P. and A.C.S.-R. are master's level public health research assistants. E.F.R., A.A., and M.B.-M. are adolescent health research experts. E.F.R. has an adolescent daughter on the autism spectrum. Our collective positionality is that we identify as people who are not autistic and who select to focus on research that we hope will benefit autistic people and society in general.What did the authors find?: Based on our four-step investigation, we identified 19 U.S. data sources that had the potential to generate estimates of the prevalence of alcohol and/or marijuana use in autistic youth. Only one included information about both autism and substance use.What do the authors recommend?: The National Institutes of Health (NIH), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Drug Abuse (NIDA), specifically, should prioritize funding data collection from autistic youth and adults on alcohol and marijuana use, misuse, hazardous use, dependence, and use disorders. In addition, it is critical that nationally representative surveys and data sources include robust questions on autism and substance abuse. This includes assessing autism status in multiple ways (e.g., self-report, diagnosis by a clinician, neuropsychology reports). Substance use questions should include age of first drink or use, frequency of use, quantity of use per day or within a certain number of hours, expectancies, consequences of use, and indicators of alcohol use disorder.How will these recommendations help autistic individuals?: These findings highlight a critical gap in the literature on substance use among autistic youth. Substance use is recognized as a pressing adolescent health problem, and autistic youth deserve evidence-based substance use prevention strategies. Without an estimate of substance use by autistic youth, it is difficult to justify to funding entities the expenditure of resources on the development of evidence-based substance use prevention strategies to benefit them.
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Autistic traits in young adults who gamble. CNS Spectr 2020; 21:1-6. [PMID: 32641183 PMCID: PMC7612193 DOI: 10.1017/s1092852920001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND. Little is known about the relationship between autistic traits and addictive behaviors such as problem gambling. Thus, the present study examined clinical characteristics and multiple facets of cognition in young adults who gamble and have autistic traits. METHODS. A total of 102 young adults who gamble were recruited from two Mid-Western university communities in the United States using media advertisements. Autistic traits were examined using the brief Autism-Spectrum Quotient (AQ-10). Clinician rating scales, questionnaires, and cognitive tests were completed. Relationships between AQ10 scores and demographic, gambling symptom, and neurocognitive measures were evaluated. RESULTS. Autistic traits were correlated with disordered gambling symptoms, attention-deficit/hyperactivity disorder (ADHD) symptoms, trait impulsivity, and some types of obsessive-compulsive symptoms. In regression, ADHD no longer significantly related to autistic traits once disordered gambling symptoms were accounted for; whereas the link between autistic traits and disordered gambling symptoms was robust even controlling for ADHD. CONCLUSIONS. These data suggest a particularly strong relationship between autistic traits and problem gambling symptoms, as well as certain aspects of impulsivity and compulsivity. The link between ADHD and autistic traits in some prior studies may have been attributable to disordered gambling symptoms, which was likely not screened for, and since individuals may endorse ADHD instruments due to other impulsive/compulsive symptom types (eg, gambling). The contribution of autistic traits to the emergence and chronicity of disordered gambling now requires further scrutiny, not only in community samples (such as this) but also in clinical settings.
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Predictive utility of autistic traits in youth with ADHD: a controlled 10-year longitudinal follow-up study. Eur Child Adolesc Psychiatry 2020; 29:791-801. [PMID: 31468149 DOI: 10.1007/s00787-019-01384-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/26/2019] [Indexed: 11/28/2022]
Abstract
The objective of this study was to investigate the stability and predictive utility of autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD). Participants were referred youth with and without ADHD, without a diagnosis of autism spectrum disorder, and their siblings, derived from identically designed longitudinal case-control family studies of boys and girls with ADHD. Subjects were assessed with structured diagnostic interviews and measures of social, cognitive, and educational functioning. The presence of ATs at baseline was operationalized using a unique profile of the Child Behavior Checklist (CBCL) consisting of an aggregate T score of ≥ 195 on the Withdrawn, Social, and Thought Problems subscales (CBCL-AT profile). At the follow-up, 83% of the ADHD youth with a positive AT profile at baseline continued to have a positive CBCL-AT profile. The presence of a positive CBCL-AT profile at baseline in youth with ADHD heralded a more compromised course characterized by a greater burden of psychopathology that emerged at an earlier age, along with poorer interpersonal, educational, and neurocognitive outcomes. Findings indicate a high level of persisting ATs in ADHD youth over time, as indexed through the CBCL-AT profile, and the presence of this profile prognosticates a compromised course in adult life in multiple domains of functioning.
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Prevalence and outcomes of young people with concurrent autism spectrum disorder and first episode of psychosis. Schizophr Res 2020; 216:310-315. [PMID: 31787480 DOI: 10.1016/j.schres.2019.11.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/05/2019] [Accepted: 11/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The intersect and blurring of boundaries between schizophrenia spectrum disorders and autism spectrum disorder (ASD) has long been an area of confusion, in both nosology and clinical practice. Individuals with a comorbid presentation of the two spectra can present with a distinct phenomenological profile to those with psychosis or ASD alone. AIMS To examine the prevalence rates of ASD in a cohort of young people presenting with a first episode of psychosis (FEP) and compare the demographic and clinical characteristics and functional outcomes between individuals with concurrent FEP and ASD, and individuals with FEP only. METHODS Young people aged 15 to 24 who presented with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1st January 2011 and 31st December 2013 were included in the study. RESULTS Of the 544 individuals presenting with a FEP, 3.7% (N = 20) had a diagnosis of ASD. Individuals with a concurrent diagnosis of FEP and ASD were more likely to be male and less likely to have comorbid substance use issues. There was no difference found in the severity of psychotic symptoms or diagnoses between groups. Those with FEP and ASD were more likely to experience impairments in interpersonal skills and be more likely to be engaged in employment or education at time of discharge from service. CONCLUSIONS Individuals with concurrent FEP and ASD can present with distinct clinical characteristics that require specialised assessment and treatment. Further large-scale studies with control groups could help to better understand the phenomenological specificity of this subgroup.
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Subthreshold autism spectrum in bipolar disorder: Prevalence and clinical correlates. Psychiatry Res 2019; 281:112605. [PMID: 31629303 DOI: 10.1016/j.psychres.2019.112605] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND While few previous studies highlighted a higher prevalence of autistic traits among adults with Bipolar Disorder (BD), little is known about their clinical significance in this population. METHOD 143 subjects with BD were enrolled at the adult psychiatric inpatient clinic of the University of Pisa. Assessments included the SCID-5, the MOODS-SR, the AQ and the AdAS Spectrum. RESULTS 42.7% of the sample scored positively for significant levels of autistic traits. Subjects with high autistic traits showed a greater likelihood of a very early onset of BD, greater length of current in-hospital stay, significantly higher rates of anxiety disorders and lower rates of substance use disorders compared to patients with low autistic traits. They also show significantly greater depressive symptoms and suicidality across the lifetime. Suicidality was associated with the altered responsiveness to sensory input and inversely related to adherence to routine and inflexibility. CONCLUSION The study is a first exploration of the clinical significance of autistic traits among BD patients. Our results highlight the clinical significance of autistic traits in patients with BD, supporting the usefulness of a dimensional approach to the autism spectrum.
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Abstract
Differences in motivation during adolescence relative to childhood and adulthood in autism was tested in a cross-sectional study. 156 Typically developing individuals and 79 individuals with autism ages 10-30 years of age completed a go/nogo task with social and non-social cues. To assess age effects, linear and quadratic models were used. Consistent with prior studies, typically developing adolescents and young adults demonstrated more false alarms for positive relative to neutral social cues. In autism, there were no changes in attention across age for social or non-social cues. Findings suggest reduced orienting to motivating cues during late adolescence and early adulthood in autism. The findings provide a unique perspective to explain the challenges for adolescents with autism transitioning to adulthood.
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Patterns of Psychiatric Comorbidity and Genetic Correlations Provide New Insights Into Differences Between Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Biol Psychiatry 2019; 86:587-598. [PMID: 31182215 PMCID: PMC6764861 DOI: 10.1016/j.biopsych.2019.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022]
Abstract
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 population-based data and analyzed their genetic correlations to evaluate underlying factors. METHODS Using data from Norwegian registries, we assessed patterns of psychiatric disorders in adults with ADHD (n = 38,636; 2.3%), ASD (n = 7528; 0.4%), and both diagnoses (n = 1467; 0.1%) compared with the remaining adult population (n = 1,653,575). We calculated their prevalence ratios (PRs) and differences using Poisson regression, also examining sex-specific relations. Genetic correlations (rg) among ADHD, ASD, and the examined psychiatric disorders were calculated by linkage disequilibrium score regression, exploiting summary statistics from relevant genome-wide association studies. RESULTS For all psychiatric comorbidities, PRs differed between ADHD and ASD. Associations were strongest in individuals with ADHD and ADHD+ASD for most comorbidities, in both men and women. The relative prevalence increase of substance use disorder was three times larger in ADHD than in ASD (PRADHD, 6.2; 95% confidence interval [CI], 6.1-6.4; PRASD, 1.9; 95% CI, 1.7-2.2; p < .001); however, the opposite was true for schizophrenia (PRASD, 13.9; 95% CI, 12.7-15.2; PRADHD, 4.4; 95% CI, 4.1-4.7; p < .001). Genetic correlations supported these patterns but were significantly different between ADHD and ASD only for the substance use disorder proxies and personality traits (p < .006 for all). CONCLUSIONS Adults with ADHD, ASD, or both ADHD and ASD have specific patterns of psychiatric comorbidities. This may partly be explained by differences in underlying genetic factors.
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Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data. Front Psychol 2019; 10:1003. [PMID: 31133937 PMCID: PMC6517475 DOI: 10.3389/fpsyg.2019.01003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/15/2019] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d's ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.
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Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819843291. [PMID: 31024216 PMCID: PMC6472168 DOI: 10.1177/1178221819843291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 12/04/2022]
Abstract
Background: Substance use disorders (SUDs) have been assumed to be rare in individuals
with autism spectrum disorder (ASD). Recent research suggests that the rates
of SUD among individuals with ASD may be higher than assumed although
reliable data on the prevalence of SUD in ASD are lacking. Typical
interventions for SUD may be particularly unsuitable for people with ASD but
research on intervention and therapy are limited. Methods: This study addresses ways of improving services for individuals with ASD and
SUD by enhancing the competence of professionals in ordinary SUD outpatient
clinics. Three therapists were given monthly ASD education and group
supervision. The participants were ordinary referred patients who wanted to
master their problems with alcohol or drugs. Four patients, all men
diagnosed with ASD and intelligence quotient (IQ) ⩾ 70 completed the
treatment. The participants were given cognitive behavioural therapy (CBT)
modified for their ASD over a minimum of 10 sessions. The therapies lasted
between 8 and 15 months. Standardised assessments were conducted pre- and
post-treatment. Results: Post-treatment, 2 participants had ended their drug and alcohol abuse
completely, 1 had reduced his abuse, and 1 still had a heavy abuse of
alcohol. Physical well-being was the most prevalent reported positive aspect
of drug or alcohol use, whereas the experience of being left out from social
interaction was the most frequent negative aspects of intoxication. Conclusions: CBT may represent a promising treatment option for individuals with ASD and
SUD. The results suggest that patients’ symptoms can be reduced by providing
monthly ASD education and group supervision to therapists in ordinary SUD
outpatient clinics. This group of patients need more sessions than other
client groups, the therapy has to be adapted to ASD, ie, direct,
individualised, and more extensive. Moreover, the patients need
psychoeducation on ASD generally, social training, and support to organise
several aspects of their lives and some patients need more support than can
be provided in an outpatient clinic.
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Late Diagnosis of Autism Spectrum Disorder. AUTISM IN ADULTHOOD 2019. [DOI: 10.1007/978-3-030-28833-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Extension of Reward-Attention Circuit Model: Alcohol’s Influence on Attentional Focus and Consequences on Autism Spectrum Disorder. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2018.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. J Autism Dev Disord 2017; 47:80-89. [PMID: 27734228 PMCID: PMC5222913 DOI: 10.1007/s10803-016-2914-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite limited and ambiguous empirical data, substance use-related problems have been assumed to be rare among patients with autism spectrum disorders (ASD). Using Swedish population-based registers we identified 26,986 individuals diagnosed with ASD during 1973–2009, and their 96,557 non-ASD relatives. ASD, without diagnosed comorbidity of attention deficit hyperactivity disorder (ADHD) or intellectual disability, was related to a doubled risk of substance use-related problems. The risk of substance use-related problems was the highest among individuals with ASD and ADHD. Further, risks of substance use-related problems were increased among full siblings of ASD probands, half-siblings and parents. We conclude that ASD is a risk factor for substance use-related problems. The elevated risks among relatives of probands with ASD suggest shared familial (genetic and/or shared environmental) liability.
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Genetic and environmental contributions to the inverse association between specific autistic traits and experience seeking in adults. Am J Med Genet B Neuropsychiatr Genet 2016; 171:1190-1197. [PMID: 26284829 DOI: 10.1002/ajmg.b.32352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/08/2015] [Indexed: 11/05/2022]
Abstract
Autistic traits are characterized by social and communication problems, restricted, repetitive and stereotyped patterns of behavior, interests and activities. The relation between autistic traits and personality characteristics is largely unknown. This study focused on the relation between five specific autistic traits measured with the abridged version of the Autism Spectrum Quotient ("social problems," "preference for routine," "attentional switching difficulties," "imagination impairments," "fascination for numbers and patterns") and Experience Seeking (ES) in a general population sample of adults, and subsequently investigated the genetic and environmental etiology between these traits. Self-reported data on autistic traits and ES were collected in a population sample (n = 559) of unrelated individuals, and in a population based family sample of twins and siblings (n = 560). Phenotypic, genetic and environmental associations between traits were examined in a bivariate model, accounting for sex and age differences. Phenotypically, ES correlated significantly with "preference for routine" and "imagination impairments" in both samples but was unrelated to the other autistic traits. Genetic analyses in the family sample revealed that the association between ES and "preference for routine" and "imagination impairments" could largely be explained by a shared genetic factor (89% and 70%, respectively). Our analyses demonstrated at a phenotypic and genetic level an inverse relationship between ES and specific autistic traits in adults. ES is associated with risk taking behavior such as substance abuse, antisocial behavior and financial problems. Future research could investigate whether autistic traits, in particular strong routine preference and impaired imagination skills, serve as protective factors for such risky behaviors. © 2015 Wiley Periodicals, Inc.
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Autism Spectrum Disorder and Co-occurring Substance Use Disorder - A Systematic Review. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:69-75. [PMID: 27559296 PMCID: PMC4990150 DOI: 10.4137/sart.s39921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research. METHODS We reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions. RESULTS A total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions. CONCLUSIONS In most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group.
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Substance-use disorder in high-functioning autism: clinical and neurocognitive insights from two case reports. BMC Psychiatry 2015; 15:149. [PMID: 26149411 PMCID: PMC4493816 DOI: 10.1186/s12888-015-0541-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low prevalence of substance-use disorder has been reported in adults with autism. However, on a superficial level, adults with high-functioning autism (HFA) display a 'normal' façade when they drink alcohol, which may explain why their alcohol dependency is not better diagnosed. CASE PRESENTATION Here, we report two cases of HFA adults who use alcohol and psychostimulants to cope with their anxiety and improve their cognitive abilities and social skills. We analyze how neurocognitive traits associated with HFA may be potential triggers for substance-use disorder. CONCLUSION Better identification of autism and its cognitive impairments, which may be vulnerability traits for developing substance-use disorders, could help improve the diagnosis and treatment of substance-use disorders among this population.
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Attention-Deficit/Hyperactivity Disorder, Autistic Traits, and Substance Use Among Missouri Adolescents. Scand J Child Adolesc Psychiatr Psychol 2014; 2:86-92. [DOI: 10.21307/sjcapp-2014-012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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