Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders Stahlberg O,
Soderstrom H, Rastam M, Gillberg C. Abstract: J Neural Transm. 2004 Jul;111(7):891-9 Findings Individuals with attention-deficit/hyperactivity disorder (ADHD) as well as autism spectrum disorder (ASD)—including autistic disorder, Asperger’s syndrome, and PDD NOS—sometimes also show symptoms of other disorders. Particularly, some adult subjects with ADHD and ASD also display bizarre ideas, disorganized speech and cognition, and mood swings, symptoms that may indicate a diagnosis of bipolar disorder, schizophrenia, and other psychotic disorders. To diagnose ADHD or ASD, physicians typically use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which uses behaviors and symptoms to exclude or include a particular disorder. However, diagnostic categories in the DSM-IV have such exclusion criteria in addition to the symptom criteria, requiring that a specific diagnosis may not be made in the presence of another. For example, it is unclear how psychosis should be diagnosed in ASD, and whether or not the additional diagnosis of ADHD is precluded in ASD. To determine the extent of co-existing (comorbid) psychotic disorders in adults with ASD or ADHD, Dr. Stahlberg and his colleagues studied the prevalence and patterns of comorbid bipolar and psychotic disorders in adult men and women with an initial diagnosis of ADHD and/or ASD. A total of 129 subjects (79 men, 50 women, mean age 30.6 years) had ASD (13 autism, 49 Asperger’s disorder, and 67 atypical autism), and 161 subjects (85 men, 76 women, mean age 32.2 years) had ADHD. Of the 129 subjects with ASD, 38% showed comorbid ADHD; of the 161 subjects with ADHD, 30% also had ASD. They also found that 7% of the subjects with ASD also had bipolar disorder with psychotic features, and 7.8% had schizophrenia or another psychotic disorder. For the 161 patients with ADHD, 5.0% showed symptoms of bipolar disorder, and 5.0% exhibited psychotic features. Conclusions This study demonstrates a considerable overlap between ASD and ADHD. Although there are some problems in diagnosing both conditions in the same individual under the DSM-IV criteria, ASD and ADHD often exist together in the same individual. In addition, the presence of symptoms for bipolar disorder and psychotic disorder (Schizophrenia, for example) in 5-8% of the subjects diagnosed with ASD or ADHD suggests that the current DSM-IV diagnostic criteria should be revised to include the possibility of these comorbid disorders. |