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Table 1 Summary of studies published between 2000–2011 exploring psychiatric comorbidity in asperger syndrome and high functioning autism

From: Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges

  Study Type of study Sample characteristica N/Age (M ± SD) Control Group(s)b N/Age (M ± SD) Assessment of psychiatric comorbidityc Findings
DEPRESSION Green et al., 2000 [6] Comparison between AS and CD. 20 AS (13.75) Range: 11-19 20 CD (14.47) Range: 11-19 ICD-10 Asperger showed higher rates of depression than controls. Chronic unhappiness and loneliness were more commonly associated with AS.
Kim et al., 2000 [7] Follow-up to clinic series. 19 AS 40 HFARange: 9-14 1751 CG Range: 9-14 OCHS-R 17% had clinically relevant depression scores. Depression correlated with anxiousness and externalizing behavior.
Barnhill, 2001 [8] Descriptive study of depressive symptoms. 33 AS Range: 12-17 None CDI 54% reported depressive symptoms, with a significant positive relationship between depression symptoms and ability attribution for social failure.
Hedley et al., 2006 [9] Relationship between social comparison processes and depressive symptoms. 36 AS (12.9 ± 1.94) Range: 10-16 None SCS CDI Participants who perceived themselves as being more dissimal to others reported higher depressive symptoms.
Meyer et al., 2006 [10] Cross-selectional study about depression in AS. 31 AS (10.1 ± 1.9) 33 CG (10.2 ± 1.9) BASC-SRP BASC-PRS The children themselves reported greater symptoms of anxiety and depression.
Whitehouse et al., 2009 [11] Relationship between loneliness and depressive symptoms in AS 35 AS (14.2 ± 0.8) 35 CG (14.4 ± 0.10) CES-DC Around two thirds (n = 23) of the adolescent with AS self-reported significantly higher levels of depressive symptoms than control group.
Lugnegård et al., 2011 [12] Evaluation of psychiatric comorbidity 54 AS (27.0 ± 3.9) None SCID 70% had experienced at least one episode of major depression, and 27 of these (50% of the total group) had recurrent major depressions.
BIPOLAR Munesue et al., 2008 [13] Study of mood disorders in consecutive outpatients. 44 HFA Range: 13-39 None DSM-IV Sixteen patients (36.4%) were diagnosed with mood disorder. Among these bipolar disorder accounted for 75% of cases.
Hofvander et al., 2009 [14] Evaluation of psychiatric and psychosocial problems in ASD with normal IQ 5AD 67 AS 50 PDD-NOS Range: 16-60 None DSM-IV In the AS subgroup the most common life-time comorbid condition was mood disorder (n = 65, 53%). Criteria for a bipolar disorder (BP) were met by 10 subjects (8%), five of whom had bipolar I subtype and two bipolar II, while three were coded as unknown subtypes.
Lugnegård et al., 2011 [12] Evaluation of psychiatric comorbidity 54 AS (27.0 ± 3.9) None SCID Five participants (9% of total group) met criteria for bipolar II disorder, whereas none met criteria for bipolar I disorder.
ANXIETY Green et al., 2000 [6] Comparison between AS and CD. 20 AS(13.75) Range: 11-19 20 CD (14.47) Range: 11-19 ICD-10 Asperger showed more symptoms of general anxiety and OCD than CD
Gillott et al., 2001 [15] Measures of anxiety and social worries. 15 HFA Range: 8-12 30 CG Range: 8-12 SCAS SWQ HFA group showed higher rates of anxiety than in typically developing or language impaired children. 7 of 15 children with HFA were at or above clinical mean score.
Burnette et al., 2005 [16] Relations between the weak central coherence hypothesis, theory of mind skills, and social-emotional functioning. 23 HFA (11. 25 ± 1.57) 20 CG (11.00 ± 1.32) BASC-SRP SASC-R Autistic subjects self-reported significantly more social anxiety symptoms
Pfeiffer et al., 2005 [17] Relationships between sensory modulation and symptoms of affective disorders. 50 AS Range: 6-17 None MASC Significant correlation was found between sensory defensiveness and anxiety in children with AS
Russell and Sofronoff, 2005 [18] Examination of anxiety and social worries in AS. 65 AS Range: 10-13 261 CG Range: 10-13 SCAS SWQ AS self-reported levels of anxiety symptoms significantly higher than control group
Meyer et al., 2006 [10] Cross-selectional study about anxiety in AS. 31 AS (10.1 ± 1.9) 33 CG (10.2 ± 1.9) BASC-SRP BASC-PRS AS self-reported high social anxiety levels correlating with their social perception, understanding and experience.
Sukhodolsky et al., 2008 [19] Study of the frequency of anxiety symptoms in PDD. 171 ASD (8.2 ± 2.6) None CASI 73 (43%) had a pathological scores for at least one anxiety disorder. Higher levels of anxiety were associated with higher IQ, functional language use, and stereotyped behaviors.
Kuusikko et al., 2008 [20] Association between AS/HFA and social anxiety symptoms. 54 HFA/AS (11.2 ± 2.2) 305 CG (12.2 ± 2.2) SPAI-C SASC-R CBCL Adolescents with HFA/AS suffered from more symptoms of social anxiety than the community sample on all measures.
Lugnegård et al., 2011 [12] Evaluation of psychiatric comorbidity 54 AS (27.0 ± 3.9) None SCID 56% met criteria for at least one anxiety disorder, and 11 of these fulfilled diagnostic criteria for two or more anxiety disorder diagnoses. 22% had social anxiety disorder, 22% had generalized anxiety disorder, 13% had panic disorder, 15% had agoraphobia and 7% had OCD.
OCD Russell et al., 2005 [21] Study of Obsessive Repetitive behaviours in AS and OCD groups. 40 AS/HFA (27.9 ± 8.5) 45 OCD (36.6 ± 11.5) Y-BOCS The two groups had similar frequencies of obsessive-compulsive symptoms. Somatic obsession and repeating rituals were more common in the OCD group.
South et al., 2005 [22] Study of the four repetitive behavior categories, comparing AS/HFA and CG. 19 AS (14.10±3.47), 21 HFA (14.28±3.02) 21 CG (13.34 ± 3.28) RBI, YSII The CG showed lower scores than AS/HFA for all four repetitive behavior categories: Object Use; Motor Movements; Rigid Routines and Circumscribed Interests.
Zandt et al., 2007 [23] Study of the types of ripetitive behaviours in ASD. 19 ASD (10.97 ± 2.42) 17 OCD (12.30 ± 2.17), 18 TD (11.942.94) RBQ, CY-BOCS Children with ASD reported more compulsions and obsessions than typically developing children. Consideration of the type of compulsions and obsessions in each disorder suggests that the compulsions in ASD tended to be less sophisticated.
Ruta et al., 2009 [24] Examination of the occurrence and characteristic features of obsessive–compulsive behaviours. 18 AS (10.61 ± 1.91) 20 OCD (11.65 ± 1.69), 22 TD (10.68 ± 2.01) CY-BOCS The AS group displayed slightly higher frequencies of Saving/Hoarding and Ordering clusters compared to OCD group.
Mack et al., 2010 [25] Clinical characteristics and symptoms severity in patients with OCD + AS/HFA; OCD + TS or OCD alone. 12AS/HFA + OCD Range:12-18 12 OCD + TS Range: 9–17, 12 OCD Range: 9-17 Y-BOCS Children with ASD may experience a similar level of impairment, equally distressing, time consuming and contributing to a similar level of interference in functioning from obsessive/compulsive symptoms as compared to children with TS plus OCD and children with OCD only.
Lai et al., 2011 [26] Behavioral Comparison of Male and Female Adults with High Functioning Autism Disorders. 68 AS/HFA Range: 18-45 None BAI, BDI, OCI-R A significant proportion of adults with AS/HFA showed clinically significant anxiety, depression, or obsessive-compulsive symptoms. Overall male and female adults with ASC were not different on these symptoms.
ADHD Holtman et al., 2005 [27] Study of the frequency of ADHD-like symptoms in AS/HFA 104 AS/HFA Range: 3.4-20.2 None CBCL Sixty-five percent of the subjects scored above the clinical cut-off on the attention problems scale
  Tani et al., 2006 [28] Exploration of childhood ADHD problems retrospectively 20 AS (27.2 ± 7.3) 10 TD (26.5 ± 8.1) WURS AS group displayed higher scores as indicated from self- and parents-report.
  Simonoff et al., 2008 [29] Assessment of psychiatric disorders in ASD 112 ASD (11.5) Range: 10–13.9 None DSM-IV 70.8% of ASD children had at least one current psychiatric disorder. The most common comorbidities were social anxiety (29.2%), ADHD (28.1%), and oppositional defiant disorder (28.1%).
  Mattila et al., 2010 [30] Community- and clinic-based study exploring comorbid psychiatry in AS/HFA 50 AS/HFA (12.7 ± 1.5) None K-SADS-PL CGAS One or more comorbid psychiatric disorders were diagnosed in 74% of the cases. The most common disorders were behavioural (44%), anxiety (42%) and tic disorders (26%).
  Mukaddes et al., 2010 [31] Comparison the rate and type of psychiatric comorbidity in children and adolescents HFA/AS 30 AS, 30 HFA None K-SADS-PL The rate of comorbid psychiatric disorders was very high in both groups. The most common disorder in both groups was attention deficit hyperactivity disorder. The AS group displayed greater comorbidity with depressive disorders and ADHD.
  1. a Sample characteristic: AS = Asperger’s Syndrome, HFA = High-functioning Autism, ASD = Autism Spectrum Disorders, PDD-NOS = Pervasive Developmental Disorder-Not otherwise Specified.
  2. b Control Group(s): CD = Conduct Disorder, AD = Autistic Disorder, CG = Control Group, OCD = obsessive Compulsive Disorder, TD = Typically developing, TS = Tourette Syndrome.
  3. c Assessment of psychiatric comorbidity: ICD-10 = Tenth revision of the International classification of disease, OCHS-R = Ontario Child Health Study-Revised, CDI = Children’s Depression Inventory, SCS = Social Comparison Scale, BASC-SRP = Behaviour Assessment System for Children-Self Report of Personality, BASC-PRS = Behaviour Assessment System for Children-Parent Report Scale, CES-DC = Centre for Epidemiological Studies Depression Scale, SCID = Structured Clinical Interview for DSM-IV Axis I Disorders, DSM-IV = Diagnostic and statstical manual of mental disorders (4th ed.), SCAS = Spence Children's Anxiety Scale, SWQ = Spence Social Worries Questionnaire, SASC-R = Social Anxiety Scale for Children-Revised, MASC = Multidimensional Anxiety Scale for Children, CASI = Child and Adolescent Symptom Inventory, SPAI-C = Social Phobia and Anxiety Inventory for Children, CBCL = Child Behavior Checklist, Y-BOCS = Yale Brown Obsessive Compulsive Scale and Symptom Checklist, RBI = Repetitive Behavior Interview, YSII = Yale Special Interests Interview, RBQ = Repetitive Behaviour Questionnaire, CY-BOCS = Children's Yale Brown Obsessive-Compulsive Scale, BAI = Beck Anxiety Inventory, BDI = Beck Depression Inventory, OCI-R = Obsessive Compulsive Inventory-Revised, WURS = Wender-Utah Rating Scale, K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version, CGAS = Children’s Global Assessment Scale.