Abstract
Recent estimates regarding prevalence of Autism Spectrum Conditions (ASCs) in community samples range between 1 and 1.5 per 100 [1]. ASCs are associated with increased rates of comorbid psychiatric disorders including depression, anxiety disorders and obsessive compulsive disorder [2]. The main diagnostic and treatment issues in those presenting with ASC and psychiatric comorbidity are non-recognition of an existing ASC and misdiagnosis of an ASC occurring with another disorder such as psychosis [3]. Both non-recognition and misdiagnosis are likely to significantly impair treatment and delay recovery.
At Orygen Youth Health, a mental health service for 15 to 25 year olds in Melbourne, Australia, we conducted an audit of all current cases in November 2007 to ascertain the prevalence of ASCs within the service. Treating clinicians were interviewed using a specific audit tool to determine whether any of the clients on their caseloads had an existing formal diagnosis of ASC or appeared to meet DSM-IV criteria for an ASC. The interview was preceded by three local professional development sessions on diagnosis, treatment and comorbidity of mental illness and ASC provided by the study lead author (R.F.).
Information on ASC status was obtained for 476 of the 523 current patients. A total of 3.4% (n = 16) had a confirmed diagnosis of ASC and 7.8% (n = 37) were reported by case managers to have a possible ASC diagnosis. A total of 3.4% (n = 10) of those with psychotic disorders and 4.1% (n = 5) of those with mood and anxiety disorders had a confirmed diagnosis of ASC. There was no relationship between ASC status and gender χ2 (2) = 2.91, p = 0.233, however there was a significant difference between the three groups with respect to age, F(2, 473) = 7.78, p < 0.001, with post hoc analyses (using Games-Howell test) revealing that those with a confirmed diagnosis of ASC were significantly younger on average than those with either possible ASC (p = 0.002) or no ASC (p < 0.001).
It is interesting that this audit did not find a gender difference in those with ASC as it is generally agreed that there is a 4:1 male female ratio [4]. This may be because there was a female predominance in this clinical sample. Those with a confirmed ASC diagnosis were younger than those without in this sample, which may represent the additional impact of having an ASC as well as psychiatric illness.
These results raise some important issues for clinicians, service developers and commissioners. There are considerably higher rates of confirmed ASCs within this clinical service compared to community settings, with the possibility that there are also additional undiagnosed cases. If these ASCs are not recognized it is unlikely that treatment will be optimal. Following this audit, and with support from the Victorian Government, a developmental disorders clinic was established in Orygen Youth Health in 2009. It is hoped that through raising awareness of ASCs within youth and adult mental health settings that services might develop to provide expert treatment for a complex group of individuals who appear to be more prevalent than appreciated in such settings.