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Cited by 111Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesChild and Adolescent Psychosocial and Emotional Development

ASD, a Psychiatric Disorder, or Both? Psychiatric Diagnoses in Adolescents with High-Functioning ASD

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Mazefsky, Carla A., Oswald, Donald P., Day, Taylor N., Eack, Shaun M., Minshew, Nancy J., Lainhart, Janet E.·2012·Journal of Clinical Child & Adolescent Psychology
DOI 10.1080/15374416.2012.686102PMC PMC3601822
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Abstract

Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview in adolescents with high-functioning autism. Participants included 35 predominantly Caucasian and male verbal 10- to 17-year-olds with a confirmed autism spectrum disorder and without intellectual disability. The average age of autism spectrum diagnosis was 11 years old. Lifetime psychiatric diagnoses were established via the Autism Comorbidity Interview, developed to identify comorbid conditions within the context of autism. Autism Comorbidity Interview results were compared to parent report of prior community psychiatric diagnoses. Approximately 60% of prior psychiatric diagnoses were not supported on the Autism Comorbidity Interview; the lowest diagnostic concordance was for prior bipolar disorder and obsessive-compulsive disorder diagnoses. Although 51% of children met Autism Comorbidity Interview criteria for at least one psychiatric disorder, rates of prior diagnoses were much higher, with 77% having at least one prior psychiatric diagnosis and 60% having two or more. Although many participants met criteria for comorbid psychiatric disorders, the majority of previous psychiatric diagnoses were not supported when autism-related manifestations were systematically taken into account. These findings require replication and may not generalize to lower functioning and earlier diagnosed children with autism spectrum disorder. Results emphasize the importance of increasing awareness of the manifestations of high-functioning autism in order to improve accuracy of diagnosis and appropriateness of interventions.

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  • ASD symptoms might be misattributed as ADHD symptoms in a child diagnosed with ADHD, and vice versa.

    “symptoms of ASD might be misattributed as ADHD symptoms in a child diagnosed with ADHD and vice versa.96,97”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [97]

    The Results (page unavailable) report that nearly one third of the adolescents with ASD had prior ADHD diagnoses that the autism-specific interview did not support. The Discussion says ASD-related symptoms may be attributed to another disorder and also describes the general possibility of comorbid symptoms being mistaken for ASD. It does not specifically establish the reverse ADHD-to-ASD misattribution in a child diagnosed with ADHD. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Differential diagnosis problems can reduce the validity of the research base and harm children and families through inaccurate diagnoses and delayed appropriate treatment.

    “Such problems with differential diagnoses can reduce the validity of the research base and negatively impact children and their families due to inaccurate diagnoses and delays in implementing appropriate treatments.97”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [97]

  • There is growing concern that psychiatric diagnoses may be over-used in autism spectrum disorder.

    “For all of these reasons, there is growing concern that psychiatric diagnoses may be over-used in ASD.15”

    From Emotion Regulation (2014) · cites this paper as [15]

  • Emotion regulation problems may manifest differently in autism spectrum disorder.

    “Further, ER problems may manifest differently in ASD.15,38,59”

    From Emotion Regulation (2014) · cites this paper as [15]

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Authors
Mazefsky, C. A., Oswald, D. P., Day, T. N., Eack, S. M., Minshew, N. J., & Lainhart, J. E.
Affiliations
  • University of Pittsburgh (US)
  • Commonwealth Autism Services
  • University of Utah (US)
Corresponding author
Mazefsky, Carla A.
ORCID
Venue
Journal of Clinical Child & Adolescent Psychology
Publisher
Informa UK Limited
Published
2012-05-29
Volume
41
Issue
4
Pages
516-523
ISSN
  • 1537-4416 (ISSN-L)
  • 1537-4424
DOI
10.1080/15374416.2012.686102
PMC
PMC3601822
OpenAlex
W2128271910
Cited by
111
References
25
Citations by year
2026: 5 · 2025: 5 · 2024: 11 · 2023: 3 · 2022: 11 · 2021: 10 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 6 · 2016: 10 · 2015: 10 · 2014: 8 · 2013: 7 · 2012: 2
FWCI
4.42
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Child & Adolescent Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD060601, P01HD035476, K23HD060601, P50HD055748, HD35476-02, HD 055748)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
high-functioning autism, autism spectrum disorder, psychiatric comorbidity, diagnostic agreement, bipolar disorder, obsessive-compulsive disorder, emotional dysregulation, adolescents, autism diagnosis
MeSH terms
Adolescent, Age Factors, Mental Disorders, Child, Child Development Disorders, Pervasive, Female, Humans, Interview, Psychological, Male, Intellectual Disability

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