The physical and mental health of middle aged and older adults on the autism spectrum and the impact of intellectual disability

Abstract

Background: People on the autism spectrum may have more physical and mental health conditions in midlife and old age compared to the general population. This study describes the physical and mental health of a unique sample of all middle aged and older Wisconsin Medicaid beneficiaries with an autism spectrum disorder diagnosis and tests differences between those with and without co-occurring intellectual disability. Method: Using de-identified Medicaid claims data for 143 adults with a recorded autism spectrum disorder diagnosis aged 40-88 years with any Wisconsin Medicaid claims in 2012 through 2015, we extracted diagnoses for physical and mental health conditions from fee-forservice claims. Logistic regression analyses-controlling for sex, race, and age-compared the adjusted odds of physical and mental health conditions for those with and without intellectual disability. Results: Many physical and mental health conditions, including immune conditions (70.6%), cardiovascular disease (49.0%) and its risk factors (46.2%), sleep disorders (85.3%), gastrointestinal disorders (49.7%), neurologic conditions (55.9%), and psychiatric disorders (72.0%) were highly prevalent in our full sample. Although there were many similarities between those individuals with and without co-occurring intellectual disability, middle aged and older adults on the autism spectrum had higher prevalence of epilepsy and lower prevalence of depression and anxiety compared to those without co-occurring intellectual disability. Conclusions: Findings suggest that people on the autism spectrum have a high prevalence of physical and mental health conditions in midlife and old age, regardless of intellectual disability status.

The Mental and Physical Health Profiles of Older Adults Who Endorse Elevated Autistic Traits

“…No significant differences in diagnosis rates were observed between high and low autistic trait groups across most physical diagnoses, including cardiovascular, metabolic, or endocrine conditions. Furthermore, no group differences were observed in total number of co-occurring Downloaded from https://academic.oup.com/psychsocgerontology/advance-article/doi/10.1093/geronb/gbaa112/5881354 by Goldsmiths College user on 11 August 2020 A c c e p t e d M a n u s c r i p t physical conditionsalthough this did correlate positively with age in both groups, as would be expected (Bishop-Fitzpatrick & Rubenstein, 2019;Croen et al, 2015;Rydzewska et al, 2019). To the authors" knowledge, no other studies have collectively explored the prevalence rates of physical conditions among those with elevated autistic traits of any age range.…”

“…Several clinical and population-based studies have documented that autistic children and adults experience increased rates of almost all mental health difficulties when compared to neurotypical individuals (Bishop-Fitzpatrick & Rubenstein, 2019;Croen et al, 2015;Hand, Angell, Harris, & Carpenter, 2019;Lever & Geurts, 2016;Lugo-Marín et al, 2019;Rydzewska et al, 2019;Simonoff et al, 2008). An association has also been reported between elevated (but subclinical) autistic traits and mental health problems.…”

Prevalence of mental health conditions, sensory impairments and physical disability in people with co-occurring intellectual disabilities and autism compared with other people: a cross-sectional total population study in Scotland

“…However, ORs revealed a decreased likelihood of anxiety and depression for individuals with both autism and intellectual disabilities and a higher likelihood of epilepsy compared with those with autism only. 15 As the adults in this study were registered with Medicare, the sample may represent a lower socioeconomic group than those with autism in the general population. Given the age of the sample, and the changes in diagnostic criteria for autism, this sample may not represent adults who are at the high functioning end of the spectrum.…”

Measuring Depression in Autistic Adults: Psychometric Validation of the Beck Depression Inventory–II

“…Although ASD is often thought of as a childhood disorder, the challenges faced by individuals on the autism spectrum continue and are often magnified in adulthood (Howlin & Magiati, 2017;Kraper et al, 2017). Notably, psychiatric comorbidities are quite common in this population, with the majority of adults with ASD meeting criteria for one or more additional psychiatric diagnoses (Bishop-Fitzpatrick & Rubenstein, 2019;Croen et al, 2015;Davignon et al, 2018;Griffiths et al, 2019;Hofvander et al, 2009;Hollocks et al, 2019;Howlin & Magiati, 2017;Lever & Geurts, 2016;Nylander et al, 2018;Supekar et al, 2017;Vohra et al, 2017). Among comorbid conditions in adults with ASD, major depressive disorder is exceedingly common, with an estimated 23% current prevalence and 37% lifetime prevalence in this population (Hollocks et al, 2019).…”