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Psychiatric Disorders in Children With Autism Spectrum Disorders: Prevalence, Comorbidity, and Associated Factors in a Population-Derived Sample
Open accessAbstract
Objective Autism spectrum disorders are now recognized to occur in up to 1% of the population and to be a major public health concern because of their early onset, lifelong persistence, and high levels of associated impairment. Little is known about the associated psychiatric disorders that may contribute to impairment. We identify the rates and type of psychiatric comorbidity associated with ASDs and explore the associations with variables identified as risk factors for child psychiatric disorders.Method A subgroup of 112 ten- to 14-year old children from a population-derived cohort was assessed for other child psychiatric disorders (3 months' prevalence) through parent interview using the Child and Adolescent Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety disorders, depressive disorders, oppositional defiant and conduct disorders, attention-deficit/hyperactivity disorder, tic disorders, trichotillomania, enuresis, and encopresis were identified.Results Seventy percent of participants had at least one comorbid disorder and 41% had two or more. The most common diagnoses were social anxiety disorder (29.2%, 95% confidence interval [CI)] 13.2-45.1), attention-deficit/hyperactivity disorder (28.2%, 95% CI 13.3-43.0), and oppositional defiant disorder (28.1%, 95% CI 13.9-42.2). Of those with attention-deficit/hyperactivity disorder, 84% received a second comorbid diagnosis. There were few associations between putative risk factors and psychiatric disorder.Conclusions Psychiatric disorders are common and frequently multiple in children with autism spectrum disorders. They may provide targets for intervention and should be routinely evaluated in the clinical assessment of this group.
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“The most common co-occurring psychiatric conditions are anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), depressive disorders, and oppositional defiant and conduct disorders (Simonoff et al. 2008), while the most common co-occurring medical conditions include gastro-intestinal problems, sleep difficulties, and seizures (Muskens et al. 2017).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Simonoff et al. 2008
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Co-occurring psychiatric and medical disorders are common among individuals with ASD, with estimates suggesting that 63–78% of individuals with ASD have at least one co-occurring psychiatric condition (Simonoff et al. 2008; Strang et al. 2012), and approximately 10–77% have at least one co-occurring medical condition (Muskens et al. 2017; Betancur 2011).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Simonoff et al. 2008
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Typically, larger sex/gender differences are reported in clinical studies, but infrequently the same patterns emerge in population-based studies78,82–84.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [83]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“En el estudio de Simonoff et al. (2008), se detectó que el 29,2 % de una muestra de niños entre 10 y 14 años presentaban ansiedad y/o depresión de forma concurrente, con tasas mucho más altas que las observadas en población general.”
From Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa (2022) · cites this paper as Simonoff et al. (2008)
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“The most common mental health challenge for autistic individuals is anxiety [14-16]”
From Autistic Cognition: Charting Routes to Anxiety (2021) · cites this paper as [16]
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“It is estimated that around 50 % of children with ASD will experience significant anxiety (Simonoff et al. 2008).”
From Towards a Treatment for Intolerance of Uncertainty in Young People with Autism Spectrum Disorder: Development of the Coping with Uncertainty in Everyday Situations (CUES©) Programme. (2017) · cites this paper as Simonoff et al. 2008
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The majority of autistic children, adolescents and adults have one or more associated mental health conditions (Buck et al., 2014; Simonoff et al., 2008), with co-occurring anxiety disorders among the most common concerns.”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Simonoff et al., 2008
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Besides the core symptoms, ASD subjects commonly present co-occurring symptoms that include anxiety and intellectual disability 37, 38.”
From Autism-like social deficit generated by Dock4 deficiency is rescued by restoration of Rac1 activity and NMDA receptor function. (2021) · cites this paper as [37]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Co-occurring psychiatric and medical disorders are common among individuals with ASD, with estimates suggesting that 63–78% of individuals with ASD have at least one co-occurring psychiatric condition (Simonoff et al. 2008; Strang et al. 2012), and approximately 10–77% have at least one co-occurring medical condition (Muskens et al. 2017; Betancur 2011).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Simonoff et al. 2008
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“Parents of autistic children can experience chronic stressors, including high levels of mental health problems in their autistic youth (e.g. Simonoff et al., 2008).”
From Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial (2024) · cites this paper as Simonoff et al., 2008
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“Mental health distress is highly prevalent in autistic adolescents, with up to 70% of autistic adolescents in a community-sourced sample meeting criteria for any DSM-5 disorder (Hollocks et al., 2022) and 41% of youth meeting criteria for more than one psychiatric condition (Simonoff et al., 2008).”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Simonoff et al., 2008
The cited source says what the claim attributes to it.
In the citing paper
“which is a major problem for a lot of autistic people”
From Autistic Cognition: Charting Routes to Anxiety (2021) · cites this paper as [16]
The cited source says what the claim attributes to it.
In the citing paper
“with co-occurring anxiety disorders among the most common concerns.”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Simonoff et al., 2008
The cited source says what the claim attributes to it.
In the citing paper
“However, the balance between avoiding misdiagnoses and recognizing the effect that ADHD symptoms have on a child with ASD has shifted because a high frequency of ADHD in children with autism has been documented (Leitner 2014, Simonoff et al. 2008).”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Simonoff et al. 2008
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In the citing paper
“other studies have identified different patterns of regression [60-64]”
From DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes (2013) · cites this paper as [63]
Experimental — accuracy not yet measuredIn the citing paper
“Despite the widespread opinion amongst clinicians that the co-occurrence profiles differ between sexes/genders80,81 — with males more likely to show externalizing problems such as oppositional defiant disorder and conduct disorder, and females more likely to show internalizing problems such as anxiety and mood disorders — the evidence is inconsistent.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [83]
In the citing paper
“Population-based research, as opposed to clinical studies, has often failed to identify these sex/gender differences in psychiatric illnesses82–84.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [83]
In the citing paper
“First, approximately 30% of children and adolescents with ASD receive a co-morbid diagnosis of ADHD (Leyfer et al., 2006; Simonoff et al., 2008)”
From Atypical attentional networks and the emergence of autism (2013) · cites this paper as Simonoff et al., 2008
In the citing paper
“In clinical cases, other neurodevelopmental conditions, psychiatric disorders and somatic disorders are often co-occurring complications [13–15].”
From The contribution of environmental exposure to the etiology of autism spectrum disorder (2019) · cites this paper as [14]
In the citing paper
“Rates of comorbid ADHD symptoms in children with ASD range from 37–85%,62 with ADHD the second-most common comorbidity in ASD.63”
From Progress and roadblocks in the search for brain-based biomarkers of autism and attention-deficit/hyperactivity disorder (2017) · cites this paper as [63]
In the citing paper
“A shared behavioural/cognitive phenotype is inattention.4, 5”
From Disorder-specific functional abnormalities during sustained attention in youth with Attention Deficit Hyperactivity Disorder (ADHD) and with Autism (2013) · cites this paper as [4]
In the citing paper
“About 30% of ASD patients have comorbid Attention Deficit Hyperactivity Disorder (ADHD),3, 4”
From Disorder-specific functional abnormalities during sustained attention in youth with Attention Deficit Hyperactivity Disorder (ADHD) and with Autism (2013) · cites this paper as [4]
In the citing paper
“The high rate of co-occurrence between autism and other neurodevelopmental disorders, such as ADHD (Simonoff et al., 2008), suggests that there may be common risk factors.”
From From early markers to neuro-developmental mechanisms of autism (2014) · cites this paper as Simonoff et al., 2008
In the citing paper
“Similarly, ASD is frequently accompanied by co-occurring conditions that are targeted for intervention to minimize the impairments that are more generally associated with ASD [70][71][72].”
From Treatment for Co-Occurring Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder (2012) · cites this paper as [71]
In the citing paper
“Co-occurring mental health conditions have been reported in approximately 70% of autistic individuals ranging from attention deficit and hyperactivity disorder (ADHD), irritability, aggression, mood, and anxiety issues [8, 25, 26].”
From An Update on Psychopharmacological Treatment of Autism Spectrum Disorder (2022) · cites this paper as [8]
In the citing paper
“The most common psychiatric disorder associated with ASD is anxiety 31”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [31]
In the citing paper
“Psychiatric disorders occur in up to 70% of patients with ASD.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [31]
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Metadata
- Authors
- Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G.
- Affiliations
- King's College London (GB)
- University of London (GB)
- Corresponding author
- Simonoff, Emily
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 47
- Issue
- 8
- Pages
- 921-929
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2158063953
- Semantic Scholar
- 8540dbed80a7b69efa29148b4a342c485751e247
- Cited by
- 3,399
- References
- 50
- Citations by year
- 2026: 121 · 2025: 151 · 2024: 213 · 2023: 184 · 2022: 273 · 2021: 279 · 2020: 295 · 2019: 261 · 2018: 232 · 2017: 267 · 2016: 209 · 2015: 216 · 2014: 194 · 2013: 188 · 2012: 124
- FWCI
- 31.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- IOE EPrints (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, psychiatric comorbidity, child psychopathology, social anxiety disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, tic disorders, trichotillomania, enuresis, encopresis, depressive disorders, conduct disorder, anxiety disorders, prevalence, risk factors, children
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Mental Disorders, Child, Female, Humans, Male, Population Surveillance, Surveys and Questionnaires, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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