title: Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders.
abstract: BACKGROUND
  Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs.
  
  
  METHODS
  Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians.
  
  
  RESULTS
  Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects.
  
  
  CONCLUSIONS
  ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden. bjorn.hofvander@med.lu.se
authors.forename: Björn
authors.initials: B
authors.lastname: Hofvander
authors.forename: Richard
authors.initials: R
authors.lastname: Delorme
authors.forename: Pauline
authors.initials: P
authors.lastname: Chaste
authors.forename: Agneta
authors.initials: A
authors.lastname: Nydén
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wentz
authors.forename: Ola
authors.initials: O
authors.lastname: Ståhlberg
authors.forename: Evelyn
authors.initials: E
authors.lastname: Herbrecht
authors.forename: Astrid
authors.initials: A
authors.lastname: Stopin
authors.forename: Henrik
authors.initials: H
authors.lastname: Anckarsäter
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
authors.forename: Maria
authors.initials: M
authors.lastname: Råstam
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care; D020817:Asperger Syndrome / Q000175:diagnosis / Q000453:epidemiology; D001321:Autistic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007360:Intelligence / Q000145:classification*; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D009633:Nonverbal Communication / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics