Pattern of Diagnosis and Co-occurring Symptoms in Adopted Children With Autism Spectrum Disorder

Abstract

To determine whether adopted children with autism spectrum disorder (ASD) differ from the general ASD population in terms of diagnosis, internalizing and externalizing behaviors, sleep problems, and medications. METHODS:We studied 163 adoptees in the Autism Speaks Autism Treatment Network (ATN) in comparison with 5624 nonadopted ATN participants (aged 1.5-17.6 years; mean [SD] = 6.2 [3.4] years). Gender, age, race, ethnicity, IQ, and categorical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASD diagnosis were tested for differences by group (adopted versus nonadopted) by using independent-samples t tests for continuous variables and Fisher's exact tests for categorical variables. Logistic or linear regression models were used to examine the association between adoption status and several outcome variables, after controlling for covariates. RESULTS:After controlling for demographics and diagnosis, there were significant differences in group characteristics, including greater propensity for externalizing behavior (P < .001), internalizing behavior (P = .001), and sleep problems (P < .001) in the adopted population. Adoptees were also prescribed psychotropic medications (P < .001) more often than the nonadoptees. Adoptees received a diagnosis of pervasive developmental disorder-not otherwise specified significantly more frequently than controls (odds ratio = 1.8; CI = 1.3-2.5; P < .001), despite no significant difference in symptoms on standardized measures. CONCLUSIONS:These results suggest that the population of adopted children with ASD differs from the general ASD population both with regard to diagnostic subtype and co-occurring behavioral problems. Future research should evaluate the contributions of specific factors associated with adoption such as biological family history, pregnancy history, early childhood experience, and age at adoption.

Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis

“…Sleep problems contribute to heightened daytime cognitive, adaptive and behavioral problems among children and adolescents (68). The prevalence of sleep disorder related comorbidity in ASD was 19.7% in the current study based on analysis of 13 sleep study groups (18,20,23,27,36,39,40,43). Subtypes of sleep problems were not reported in most studies and were not included.…”

“…Twenty nine studies consisting of ID, ADHD, anxiety disorders, disruptive behavior disorders, bipolar disorder, depressive disorders, OCD, psychotic disorders and sleep disorders prevalence were analyzed. Seven studies had subgroups which consisted of different countries, ages or registry samples (Figure 1) (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). There were 33 study groups from 19 studies for ID (3,5,14,18,19,21,22,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), 21 study groups from 15 studies for ADHD (14,18,19,21,27,28,31,(35)(36)(37)(38)(39)…”

“…Seven studies had subgroups which consisted of different countries, ages or registry samples (Figure 1) (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). There were 33 study groups from 19 studies for ID (3,5,14,18,19,21,22,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), 21 study groups from 15 studies for ADHD (14,18,19,21,27,28,31,(35)(36)(37)(38)(39)(40)(41), 19 study groups from 12 studies for anxiety …”

Editors’ Note and Prologue

“…Parents reported higher rates relative to clinician-reported diagnoses, although medications may be prescribed even in the absence of a documented diagnosis. Greenlee et al 14 found that a history of depression in children with ASD, as reported by parents, was more common with greater chronological age (reaching 20% in those aged 13-17 years), higher cognitive level, and in those 15 Finally Ezell et al 16 described patterns of comorbidity among children with ASD who had been adopted. Compared with other children with ASD, the adopted group had more severe parent-reported behavior and sleep problems and were more commonly prescribed psychotropic medication, emphasizing the complexity of the care needs of this population.…”