The mental health needs of people with autism spectrum disorders

Autism spectrum disorders (ASDs) are characterized by restricted, repetitive behaviour and abnormalities in social interaction and communication. A prevalence rate of ASD of up to 116/10,000 has been reported. The prevalence and range of psychiatric disorders are increased in people with ASD, including those with intellectual disability. Risk factors for psychiatric disorders in this group include genetic factors, communication problems, loneliness and low self-esteem. Mental health problems may be difficult to assess, and range from attention deficit hyperactivity disorder (ADHD) and tic disorders to psychotic and mood disorders, and catatonia. Prevalence of ADHD and tic disorders is increased in people with ASD. While the presentation of depressive and bipolar disorders may be similar to that in the general populations, depression may be associated with onset of or increase in maladaptive behaviour. In contrast to checking, cleaning or counting compulsions seen in people with obsessive–compulsive disorder (OCD), people with ASD may engage in repeating, hoarding, touching and tapping behaviour. ASD has been proposed as a non-specific neurodevelopmental marker for childhood-onset schizophrenia and it is recognized that psychotic symptoms may be difficult to establish in the presence of ASD. Interestingly, catatonia has been reported in up to 17% of young people with ASD referred to a national centre. It is important to disseminate available evidence on psychiatric treatment for people with ASD, while recognizing the need for further research on treatment and outcome measures.