Anxiety Disorders in Adults with Autism Spectrum Disorder: A Population-Based Study

Victoria Nimmo-Smith,Selma Idring,Michael Lundberg,Peter Carpenter,Dheeraj Rai,Cecilia Magnusson,Christina Dalman,Hein Heuvelman

doi:10.1007/s10803-019-04234-3

Abstract

Anxiety is common in children with ASD; however, the burden of specific anxiety disorders for adults with ASD is under-researched. Using the Stockholm Youth Cohort, we compared anxiety disorder diagnoses among autistic adults (n = 4049), with or without intellectual disability, and population controls (n = 217,645). We conducted additional sibling analyses. Anxiety disorders were diagnosed in 20.1% of adults with ASD compared with 8.7% of controls (RR = 2.62 [95% CI 2.47–2.79]), with greatest risk for autistic people without intellectual disability. Rates of almost all individual anxiety disorders were raised, notably obsessive–compulsive disorder and phobic anxiety disorders. Anxiety disorders were more common in full siblings and half-siblings of people with ASD. The implications of this are explored.

Highlights

Autism spectrum disorders (ASD) are characterised by early-onset difficulties in social interaction, communication and restricted, repetitive patterns of interests and behaviour (Lai et al 2014)
Just over a fifth (20.13%) of adults with ASD had been diagnosed with an anxiety disorder compared with 8.72% of an adult non-autistic reference population, and prevalence of anxiety disorder was highest in the absence of comorbid intellectual disability (ID) (23.11%) (Tables 1 and 2)
Amongst the common anxiety disorder diagnoses, prevalence of obsessive–compulsive disorders (OCD) diagnoses was notably raised in people with ASD (3.43%) compared with the general population (0.47%) and prevalence of phobic anxiety disorders was markedly higher

Summary

Introduction

Autism spectrum disorders (ASD) are characterised by early-onset difficulties in social interaction, communication and restricted, repetitive patterns of interests and behaviour (Lai et al 2014). Studies to date of adults provide an inconsistent account with prevalence estimates ranging between 28% and 77% and are limited by differences in methodological design, small sample size (Mazefsky et al 2008; Tani et al 2012), recruitment of selected samples from secondary services, or lack of a valid comparison group (Tani et al 2012; Kanai et al 2011; Bakken et al 2010; Hutton et al 2008; Buck et al 2014; Hofvander et al 2009; Russell et al 2016; Lever and Geurts 2016). The existing evidence is difficult to generalise and may be subject to confounding and selection bias

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Conclusion