What are spectrum disorders?
Autism and spectrum disorders are neurodevelopmental disorders characterized by difficulties with communication, social interaction and repetitive behaviours or interests. The disorders that fall on the autism spectrum are autism, Asperger syndrome and atypical autism. People with these symptoms are said to be ‘on the spectrum‘ because autism is of many types and the severity of symptoms varies from person to person. Although it can be diagnosed at any age, autism is a neurodevelopmental disorder because symptoms usually become visible in the first years of life. There are exceptions, as some people with more subtle forms of the disorder disguise their symptoms to better adapt to situations and avoid social rejection. This is more common in women with above average IQ and delays the process of receiving a diagnosis. The disorder can remain unidentified until adulthood, when it manifests with other mental illnesses such as depression, anxiety or ADHD. However, the symptoms associated with autism need to be managed throughout life and can have a detrimental impact on adult life [1]. For this reason, early and correct diagnosis of autism spectrum disorders is essential.
How common are spectrum disorders in young people and adults?
The prevalence of autism is around 1% in adults, which means it is more common than conditions like diabetes. However, many adults face difficulties in accessing diagnostic and treatment services [2]. Spectrum disorders are associated with financial and emotional hardship for affected individuals, their families and society. Other mental health disorders are also common alongside autism spectrum disorders: about 70-80% of adults with autism are also affected by other conditions such as depression, anxiety, ADHD or psychotic disorders [3]. It is therefore important to raise awareness of the autism spectrum and the mental health disorders often associated with it.
Autism spectrum and depression
În timp ce în România se estimează că între 3 și 5% din oameni suferă de depresie la un moment dat în viață [4, 5], aproximativ de trei sau patru ori mai mulți adulți cu tulburări de spectru se confruntă în paralel cu simptome depresive [6].
A meta-analysis of 7857 articles published in English reported that depression in people on the spectrum is more commonly diagnosed among Caucasians with above average intellect [6]. Possible explanations are that autistic people with above average intellect are more aware of autistic symptoms and their negative impact on their lives [7]. Related to the high prevalence among Caucasians, this may also be due to the fact that methods of diagnosing depression are not adapted to other cultures and ethnicities, or that people in developing countries cannot easily access psychological or psychiatric services.
It should also be taken into account that the diagnosis of depression involves good collaboration between the clinician (psychologist and/or psychiatrist) and the patient, so that the clinician can understand the person’s concerns. For people on the spectrum, the communication of depressive symptoms is hampered by communication deficits (verbal and non-verbal) and lack of self-reflection. Also, depressive symptoms in those on the spectrum are often atypical, presenting as increased aggression, irritability and agitation, as well as fluctuating moods. Young people who experience this set of symptoms are simultaneously more likely to exhibit exacerbated compulsive states and more stereotypic behavior [8].
Autism spectrum and psychotic disorders
Spectrum and psychotic disorders often overlap, so that psychosis is found in more than 3 in 100 people with a spectrum disorder [9]. For context, psychoses occur in one in 100 people in the general population.
Both categories of disorders are considered neurodevelopmental and spectrum disorders. Both are characterized by difficulties in social interaction, such as lack of emotional reciprocity in autism and lack of natural reactions to emotional stimuli in psychosis. Also, language delay or lack of language in spectrum disorders is similar to language poverty in psychotic disorders, and impairments in executive functioning (attention, information processing) are similar for both groups. While paranoia and a pervasive sense of threat are symptoms of the psychotic spectrum, those on the autistic spectrum are reluctant to interact with or trust other people. Overall, the two groups of disorders appear to exist at different ends of a continuum [10].
Autism and psychotic disorders have an interesting history. Before autistic spectrum disorders appeared as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, they were seen as psychotic disorders that begin in childhood. Although we now know that they can occur at the same time, it is still very difficult to differentiate between certain symptoms, and research on the subject is still in its infancy. However, individuals who present with autism spectrum disorder and psychotic disorder simultaneously appear to differ from those who are diagnosed with psychotic disorder alone – that is, they are more likely to receive a diagnosis of psychotic disorder of unspecified type precisely because their clinical presentations are atypical. By the nature of autistic symptoms, this may also be due to the fact that people on the spectrum are less disturbed by the presence of hallucinations or delusions and therefore these are more difficult to identify.
Autism spectrum and ADHD
Spectrum disorders and Attention Deficit Hyperactivity Disorder (ADHD) often overlap, so that about 28-44% of adults diagnosed with autism also qualify for a diagnosis of ADHD [11]. Although the American Psychiatric Association denied until 2013 that autism and ADHD can be diagnosed simultaneously in the same person, the new Diagnostic and Statistical Manual of Mental Disorders has been adapted to claim that the two can exist simultaneously. This psychiatric comorbidity (when two psychiatric conditions occur in the same person) can be partly explained by common genetic risk factors.
Both are neurodevelopmental disorders that affect executive functioning (for example, attention, concentration and decision-making). Although the neurobiological mechanisms are not clear, the heightened interest and attention that people on the spectrum pay to certain activities is similar to the “hyperfocus” phenomenon in ADHD, when a person is so focused on an activity or subject that they become fixated on the smallest details. People with both sets of symptoms face increased problems with social integration and organization, but these can be managed with treatment.
Accessible resources on autism
Book recommendation in English: Explaining Humans, by Camilla Pang – The experiences of a young scientist with autism and ADHD
Movie recommendation: The Accountant:
https://www.imdb.com/title/tt2140479/ https://www.imdb.com/title/tt2140479/
TEDTalk tip: Autism and addictions:
https://www.youtube.com/watch?v=FU5nUEfCDdI https://www.youtube.com/watch?v=FU5nUEfCDdI
TEDTalk tip: What do children with autism do as adults?
https://www.youtube.com/watch?v=WtgGzKRHT-Y https://www.youtube.com/watch?v=WtgGzKRHT-Y
Recommended autism resources in English:
https://autismvoice.ro/exista-mai-multe-tipuri-de-autism/
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Scientific resources
[1] https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
[2] Murphy, C. M., Wilson, C. E., Robertson, D. M., Ecker, C., Daly, E. M., Hammond, N., … & McAlonan, G. M. (2016). Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatric Disease and Treatment, 12, 1669-1686.
[3] Lever, A.G., Geurts, H.M. (2016) Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 46(6): 1916–1930.
[4] Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J., … & Whiteford, H. A. (2013). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine, 10(11).
[5] Florescu, S., Ciutan, M., Popovici, G., Gălăon, M., Ladea, M., Petukhova, M. & Hoffnagle, A. (2009) The Romanian Mental Health Study: main aspects of lifetime prevalence and service use of DSM-IV disorders. Management in Health 13, 22-29.
[6] Hudson, C. C., Hall, L., & Harkness, K. L. (2019). Prevalence of depressive disorders in individuals with autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology, 47(1), 165-175.
[7] Chandrasekhar, T., & Sikich, L. (2015). Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience, 17(2), 219–227.
[8] Magnuson, K. M., & Constantino, J. N. (2011). Characterization of depression in children with autism spectrum disorders. Journal of developmental and behavioral pediatrics, 32(4), 332.
[9] Zheng, Z., Zheng, P., & Zou, X. (2018). Association between schizophrenia and autism spectrum disorder: A systematic review and meta‐analysis. Autism Research, 11(8), 1110-1119.
[10] Ciaramidaro, A., Bölte, S., Schlitt, S., Hainz, D., Poustka, F., Weber, B., … & Walter, H. (2015). Schizophrenia and autism as contrasting minds: neural evidence for the hypo-hyper-intentionality hypothesis. Schizophrenia bulletin, 41(1), 171-179.
[11] Lai, M.C., Lombrado, M.V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920):896-910.
