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Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services
Open accessAbstract
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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“Overall, ADHD appears more prevalent in male adolescents as sex was identified as a risk factor in Salazar et al. (40), and also confirmed in Brookman-Frazee et al. (37) who found that boys were 3.37 more likely to score positive for any ADHD disorder on the MINI-KID-P, while Soke et al. (42) found ADHD to be more prevalent in children aged 8y vs. 4y, with an adjusted OR = 4.78 (CI95%: 3.40–6.73).”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [37]
Experimental — accuracy not yet measuredIn the citing paper
“Brookman-Frazee et al. (37) who found that boys were 3.37 more likely to score positive for any ADHD disorder on the MINI-KID-P”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [37]
In the citing paper
“However, all three authors reported prevalence for social phobia and separation anxiety disorder of 24.00, 6.00, 9.20, and 15.00, 1.00, 3.10% respectively.”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [37]
In the citing paper
“Prevalence was further described by ADHD subtypes in Brookman-Frazee et al. (37), Mansour et al. (36), and Skwerer et al. (38) with a prevalence of 11.00, 21.00, and 40.00% respectively for the inattentive subtype, 4.00, 1.00, and 23.10% for the impulsive subtype and 62.00, 64.00, and 18.50% for both subtypes combined.”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [37]
In the citing paper
“evidence is supportive of a higher prevalence of ADHD in male compared to female individuals (32, 37, 40).”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [37]
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Citations
Cites
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Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1359 · Cited by 2,947 · cited 1×
“…gender and clinical characteristics were differentially associated with meeting criteria for each diagnostic group of ADHD, ODD, an Anxiety, or Mood Disorder with results similar to studies of non-ASD youth with MH conditions (Canino et al., 2004; Costello et al., 1996; Kessler et al., 2005, 2012).”
ResultSheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05305whi · Cited by 1,730
Comorbid psychiatric disorders in children with autism: interview development and rates of disorders
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., Tager-Flusberg, H., & Lainhart, J. E. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0123-0 · Cited by 1,637
Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2351-z · Cited by 1,584
Anxiety in children and adolescents with autism spectrum disorders
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.01.003 · Cited by 1,427 · cited 2×
“This is particularly relevant because rates of anxiety disorders in children with ASD range from 11%–84%, and this comorbidity is linked to heightened functional impairment (Kerns et al., 2015; White et al., 2009).”
Background
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Cited by
Sorted by citations
Lai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30289-5 · Cited by 1,892
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Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.744709 · Cited by 330
“In addition, evidence is supportive of a higher prevalence of ADHD in male compared to female individuals (32, 37, 40).”
BackgroundRong, Y., Yang, C.-J., Jin, Y., & Wang, Y. (2021) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2021.101759 · Cited by 316
Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood
Malik-Soni, N., Shaker, A., Luck, H., Mullin, A. E., Wiley, R. E., Lewis, M. E. S., Fuentes, J., & Frazier, T. W. (2022) · Pediatric Research · doi:10.1038/s41390-021-01465-y · Cited by 309
Metadata
- Authors
- Brookman-Frazee, L., Stadnick, N., Chlebowski, C., Baker-Ericzén, M., & Ganger, W.
- Affiliations
- University of California San Diego (US)
- Rady Children's Hospital-San Diego (US)
- San Diego State University (US)
- Corresponding author
- Stadnick, Nicole
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2017-09-15
- Volume
- 22
- Issue
- 8
- Pages
- 938-952
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- PMC
- PMC6491206
- OpenAlex
- W2754290562
- Cited by
- 174
- References
- 70
- Citations by year
- 2026: 12 · 2025: 26 · 2024: 29 · 2023: 21 · 2022: 27 · 2021: 29 · 2020: 15 · 2019: 8 · 2018: 6 · 2017: 1
- FWCI
- 4.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (NIMH Grant R01MH094317)
- 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
- autism spectrum disorder, psychiatric comorbidity, children, publicly funded mental health services, behavioral problems, attention deficit hyperactivity disorder, oppositional defiant disorder, anxiety disorders, mood disorders, gender differences
- MeSH terms
- Problem Behavior, Autism Spectrum Disorder, Adolescent, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, California, Child, Child, Preschool, Education, Special, Female, Financing, Government, Humans, Male, Medicaid, Mental Health Services, School Health Services, United States, Cohort Studies, Comorbidity, Prevalence, Logistic Models, Attention Deficit and Disruptive Behavior Disorders, Mood Disorders
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