Neurological and psychiatric disorders among autistic adults: a population healthcare record study.

This large study looked at health records for autistic adults in Wales and found they have much higher rates of mental health conditions. Depression affected 1 in 4 autistic adults, anxiety affected 1 in 5, and conditions like ADHD, bipolar disorder, and schizophrenia were 8-10 times more common than in the general population. Epilepsy was also much more frequent. This shows autistic adults face significant mental health challenges that need better recognition and support.

This population-based study examined psychiatric and neurological conditions among autistic adults using Welsh national health records (2001-2016, n=3.6 million). Compared to matched controls, autistic adults showed significantly higher rates of all examined psychiatric conditions. Depression (25.90%) and anxiety (22.40%) were most common, while ADHD, bipolar disorder, OCD, psychosis, and schizophrenia showed odds ratios 8.24-10.74 times higher than the general population. Epilepsy was 9.21 times more common.

The study highlights the substantial mental health burden in autism and suggests under-reporting and diagnostic overshadowing may affect recognition of co-occurring conditions in clinical practice.

Results indicate need for systematic mental health screening in autistic adults and awareness of high comorbidity rates. Clinicians should maintain vigilance for psychiatric conditions and avoid diagnostic overshadowing. Services require capacity to address the substantial mental health burden in this population through integrated care approaches.

Sample size not reported. Retrospective design relies on recorded diagnoses which may underestimate true prevalence due to diagnostic overshadowing. Study period (2001-2016) may not reflect current diagnostic practices. No information provided about autism diagnosis verification or severity measures.

Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54-94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (= 3.6 million).

We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation. All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24-10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism.

We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population.