Clinical Correlates of Major Depression in Psychiatrically Referred Youth With and Without Autism: A Controlled Study

This study investigates the co-occurrence between autism spectrum disorder (ASD) and major depressive disorder (MDD) in pediatric populations, focusing on prevalence rates, comorbid psychiatric conditions, and their impact on clinical presentation and treatment outcomes.

We conducted a retrospective study of children and adolescents (ages 3-17) referred for psychiatric care to ambulatory care clinics (pediatric psychopharmacology [N = 2,307] and specialized autism spectrum disorder [N = 416] programs) at a major academic medical center. Psychopathology was assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the Child Behavior Checklist (CBCL). ASD was diagnosed using DSM criteria.

Our findings revealed a co-occurrence and bidirectional relationship between ASD and MDD (55% of ASD patients had MDD, while 9% of MDD patients had ASD). The symptom profile of depression in youth with ASD was consistent with the typical DSM-based presentation. The burden of psychopathology was significantly greater in the presence of ASD and MDD comorbidity, and in particular the rates of comorbid anxiety disorders, OCD, and psychosis were significantly elevated. Social competence and global functioning were worse in the presence of ASD and MDD comorbidity.

A high prevalence of comorbidity with MDD was observed in psychiatrically referred youth with ASD, with a clinical presentation of MDD that is typical of the disorder. Higher prevalence of anxiety disorders and psychosis was observed in the presence of ASD and MDD comorbidity. These findings underscore the need for comprehensive assessment and tailored interventions for children with co-occurring ASD and MDD, particularly in addressing anxiety and ensuring adequate access to mental health services.