Related Experiment Video
Updated: Apr 15, 2026
Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis
Published on: November 21, 2013
Risks for nonaffective psychotic disorder and bipolar disorder in young people with autism spectrum disorder: a
Jean-Paul Selten1, Michael Lundberg2, Dheeraj Rai3
1School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands2Rivierduinen Psychiatric Institute, Leiden, the Netherlands.
Insights
Individuals with autism spectrum disorder (ASD) have a significantly higher risk for nonaffective psychotic disorder (NAPD) and bipolar disorder (BD). This increased risk was also observed in their siblings, suggesting a potential genetic link.
Area of Science:
- Psychiatry
- Neurodevelopmental Disorders
- Genetics
Background:
- The co-occurrence of autism spectrum disorder (ASD) with nonaffective psychotic disorder (NAPD) and bipolar disorder (BD) is not well-established.
- Understanding these associations is crucial for comprehensive patient care and management.
Purpose of the Study:
- To investigate the risk of NAPD and BD in individuals diagnosed with ASD.
- To compare these risks with those in their unaffected siblings.
Main Methods:
- A nested case-control study was conducted using the Stockholm Youth Cohort (n=9062).
- Individuals diagnosed with ASD (with and without intellectual disability) and their full siblings were followed up using Swedish registers.
- Adjusted odds ratios (ORs) were calculated for NAPD and BD.
Main Results:
- Individuals with ASD showed substantially increased adjusted ORs for NAPD (ranging from 3.5 to 12.3) and BD (ranging from 1.8 to 8.5).
- The risk for NAPD and BD was also elevated in unaffected siblings of individuals with ASD (ORs 1.8 and 1.7, respectively).
- Risks were higher when ASD was diagnosed before age 28 compared to before age 16, and varied based on intellectual disability status.
Conclusions:
- Autism spectrum disorder is associated with a significantly elevated risk of developing nonaffective psychotic disorder and bipolar disorder.
- These findings highlight the importance of monitoring for these conditions in individuals with ASD and their families.
- The results have implications for clinical management and understanding the complex etiology of these disorders.
Importance:
Whether individuals with autism spectrum disorder (ASD) are at increased risk for nonaffective psychotic disorder (NAPD) or bipolar disorder (BD) is unknown.
Objective:
To test whether the risks for NAPD and BD in individuals with ASD are increased and whether these risks are higher than those of their siblings not diagnosed as having ASD.
Design, Setting, And Participants:
We performed a nested case-control study of all individuals 17 years or younger who ever resided in Stockholm County, Sweden, from January 1, 2001, through December 31, 2011 (Stockholm Youth Cohort). We included cohort members ever diagnosed as having ASD (n = 9062) and their full siblings never diagnosed as having ASD. Each case was matched with 10 control individuals of the same sex born during the same month and year. Using Swedish registers, cases, siblings, and controls were followed up until December 31, 2011. By then, the oldest individuals had reached the age of 27 years.
Exposures:
Autism spectrum disorder, registered before age 16 or 28 years. We distinguished between ASD with and without intellectual disability (ID).
Main Outcomes And Measures:
We calculated odds ratios (ORs) for NAPD and BD adjusted for age, sex, population density of place of birth, personal or parental history of migration, hearing impairment, parental age, parental income, parental educational level, and parental history of psychiatric disorder.
Results:
The adjusted ORs for NAPD and BD for cases with non-ID ASD registered before age 16 years were 5.6 (95% CI, 3.3-8.5) and 5.8 (95% CI, 3.9-8.7), respectively; the adjusted ORs for cases with ID ASD were 3.5 (95% CI, 2.0-6.0) and 1.8 (95% CI, 0.8-4.1). The adjusted ORs for NAPD and BD in cases with non-ID ASD registered before age 28 years were 12.3 (95% CI, 9.5-15.9) and 8.5 (95% CI, 6.5-11.2), respectively; for cases with ID ASD, these ORs were 6.4 (95% CI, 4.2-9.8) and 2.0 (95% CI, 1.0-3.9), respectively. The ORs for NAPD and BD for the nonautistic full siblings of cases for whom ASD was registered before age 16 years, adjusted for hearing loss, were 1.8 (95% CI, 1.1-2.7) and 1.7 (95% CI, 1.1-2.6), respectively.
Conclusions And Relevance:
A diagnosis of ASD is associated with a substantially increased risk for NAPD and BD. This finding contributes to our understanding of these disorders and has implications for the management of ASD.
Related Concept Videos
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
01:30Bipolar Disorder
01:29Psychological and Sociocultural Causes of Schizophrenia
01:30Oppositional Defiant Disorder
Diagnostic Criteria and...
01:28Psychosis and Antipsychotic Drugs: Overview
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....