Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services

Brookman‐Frazee, Lauren; Stadnick, Nicole A.; Chlebowski, Colby; Baker-Ericzén, Mary J.; Ganger, William

doi:10.1177/1362361317712650

Cited by 118 publications

(93 citation statements)

References 68 publications

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“…The rates and patterns of probable concomitant psychiatric disorders observed in this sample were similar to those reported in children with ASD receiving publicly-funded mental health services 12 . The high rates of ODD and CD in children with ADHD have been observed in the general pediatric population and in children with ASD 14, 10 .…”

Section: Discussionsupporting

confidence: 75%

“…The prevalence estimates for all anxiety disorders are likely understated because specific phobia was not included. The high co-occurrence of ADHD and anxiety disorders in youth with ASD was also observed by Brookman-Frazee et al (2017) 12 . In the general pediatric population, by contrast, the review by Angold et al (1999) 14 reported significantly lower co-occurrence of ADHD and anxiety disorders compared to the association between ADHD and ODD/CD.…”

Section: Discussionsupporting

confidence: 63%

“…This trend was not observed in studies by Simonoff et al (2008) 10 or Brookman-Frazee et al (2017) 12 . The difference across IQ groups in our sample is greatest in anxiety disorders.…”

Section: Discussionmentioning

confidence: 52%

“…The findings suggest that boundaries of co-occurring DSM-defined disorders are blurry in this sample of children with ASD seeking treatment for disruptive behavior. The high frequency of multiple DSM-defined disorders has been reported in several studies of children with ASD using different methodologies 12, 8, 9, 10 …”

Section: Discussionmentioning

confidence: 92%

“…The most common were Social Anxiety Disorder (29%), ODD (30%), and ADHD (28%). Brookman-Frazee et al (2017) 12 reported that 92% of children with ASD (N = 201; mean age 9 years, range 4-14) receiving publicly funded mental health services in Southern California met criteria for another psychiatric disorder. The most frequently reported psychiatric disorders were ADHD (78%), ODD (58%), and Anxiety disorders (56%).…”

Section: Introductionmentioning

confidence: 99%

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An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

Lecavalier

McCracken

Aman

et al. 2019

Comprehensive Psychiatry

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 63%

“…This trend was not observed in studies by Simonoff et al (2008) 10 or Brookman-Frazee et al (2017) 12 . The difference across IQ groups in our sample is greatest in anxiety disorders.…”

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

Lecavalier

McCracken

Aman

et al. 2019

Comprehensive Psychiatry

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Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder

et al. 2020

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IMPORTANCEIt is critical to evaluate the risk of comorbid psychiatric diagnoses to meet the needs of individuals with autism spectrum disorder (ASD).OBJECTIVE To examine whether individuals with ASD are at greater risk for comorbid diagnoses of depression, anxiety, or bipolar disorder. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data from a population-based birth cohort of 31 220 individuals born in Olmsted County, Minnesota, from January 1, 1976, to December 31, 2000. Patients with research-identified ASD were previously identified using a multistep process that evaluated signs and symptoms abstracted from medical and educational records. For each of the 1014 patients with ASD, 2 age-and sex-matched referents who did not meet criteria for ASD were randomly selected from the birth cohort (n = 2028). Diagnosis codes for anxiety, depression, and bipolar disorders were electronically obtained using the Rochester Epidemiological Project records-linkage system. Data analysis was performed from July 1, 2018, to April 1, 2019. MAIN OUTCOMES AND MEASURESCumulative incidence of clinically diagnosed depression, anxiety, and bipolar disorder through early adulthood in individuals with ASD compared with referents. RESULTS A total of 1014 patients with ASD (median age at last follow-up, 22.8 years [interquartile range, 18.4-28.0 years]; 747 [73.7%] male; 902 [89.0%] white) and 2028 referents (median age at last follow-up, 22.4 years [interquartile range, 18.8-26.2 years]; 1494 [73.7%] male; 1780 [87.8%] white) participated in the study. Patients with ASD were significantly more likely to have clinically diagnosed bipolar disorder (hazard ratio [HR], 9.34; 95% CI, 4.57-19.06), depression (HR, 2.81; 95% CI,, and anxiety (HR, 3.45; 95% CI, 2.96-4.01) compared with referents. Among individuals with ASD, the estimates of cumulative incidence by 30 years of age were 7.3% (95% CI, 4.8%-9.7%) for bipolar disorder, 54.1% (95% CI, 49.8%-58.0%) for depression, and 50.0% (95% CI, 46.0%-53.7%) for anxiety. Among referents, cumulative incidence estimates by 30 years of age were 0.9% (95% CI, 0.1%-1.7%) for bipolar disorder, 28.9% (95% CI, 25.7%-32.0%) for depression, and 22.2% (95% CI, 19.3%-25.0%) for anxiety. CONCLUSIONS AND RELEVANCEThe findings suggest that individuals with ASD may be at increased risk for clinically diagnosed depression, anxiety, and bipolar disorder compared with age-and sex-matched referents. This study supports the importance of early, ongoing surveillance and targeted treatments to address the psychiatric needs of individuals with ASD.

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Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services

et al. 2019

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IMPORTANCE Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. OBJECTIVE To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. INTERVENTIONS The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. MAIN OUTCOMES AND MEASURES Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. RESULTS In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = −0.38; P = .02) and ECBI Problem (B = −1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = −1.36; P < .001) relative to the usual care group (B = −0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = −1.22; P < .001) relative to the usual care group (B = −0.20; P = .29). Therapist fidelity moderated these intervention effects. CONCLUSIONS AND RELEVANCE The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services.

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Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services

Cited by 118 publications

References 68 publications

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder

Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services

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