ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD

Area of Science:

• Neurodevelopmental Disorders
• Child and Adolescent Psychiatry
• Psychiatric Diagnostics

Background:

• Emotion dysregulation in autism spectrum disorder (ASD) complicates diagnosis.
• Inaccurate psychiatric diagnoses can delay autism diagnosis in high-functioning children.
• Autism Comorbidity Interview (ACI) is designed to identify comorbidities within the context of ASD.

Purpose of the Study:

• To assess diagnostic concordance between prior psychiatric diagnoses and ACI results in adolescents with high-functioning autism.
• To evaluate the accuracy of community-based psychiatric diagnoses when considering autism-specific manifestations.

Main Methods:

• Pilot study involving 35 verbal, high-functioning adolescents (10-17 years) with ASD.
• Lifetime psychiatric diagnoses assessed using the ACI.
• ACI results compared against parent-reported prior community psychiatric diagnoses.

Main Results:

• Approximately 60% of prior psychiatric diagnoses lacked concordance with ACI findings.
• Lowest concordance observed for bipolar disorder and obsessive-compulsive disorder.
• While 51% met ACI criteria for psychiatric disorders, 77% had prior diagnoses, often multiple.

Conclusions:

• The majority of previous psychiatric diagnoses were not supported when autism-related symptoms were considered.
• Findings underscore the need for increased awareness of high-functioning autism manifestations to improve diagnostic accuracy.
• Replication is needed; results may not apply to lower-functioning or earlier-diagnosed children with ASD.