Umbrella systematic review of systematic reviews and meta-analyses on comorbid physical conditions in people with autism spectrum disorder

Abstract

Background Comorbid physical conditions may be more common in people with autism spectrum disorder (ASD) than other people. Aims To identify what is and what is not known about comorbid physical conditions in people with ASD. Method We undertook an umbrella systematic review of systematic reviews and meta-analyses on comorbid physical conditions in people with ASD. Five databases were searched. There were strict inclusion/exclusion criteria. We undertook double reviewing for eligibility, systematic data extraction and quality assessment. Prospective PROSPERO registration: CRD42015020896. Results In total, 24 of 5552 retrieved articles were included, 15 on children, 1 on adults, and 8 both on children and adults. Although the quality of included reviews was good, most reported several limitations in the studies they included and considerable heterogeneity. Comorbid physical conditions are common, and some are more prevalent than in the general population: sleep problems, epilepsy, sensory impairments, atopy, autoimmune disorders and obesity. Asthma is not. However, there are substantial gaps in the evidence base. Fewer studies have been undertaken on other conditions and some findings are inconsistent. Conclusions Comorbid physical conditions occur more commonly in people with ASD, but the evidence base is slim and more research is needed. Some comorbidities compound care if clinicians are unaware, for example sensory impairments, given the communication needs of people with ASD. Others, such as obesity, can lead to an array of other conditions, disadvantages and early mortality. It is essential that potentially modifiable physical conditions are identified to ensure people with ASD achieve their best outcomes. Heightening clinicians’ awareness is important to aid in assessments and differential diagnoses, and to improve healthcare.

The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison

“…Individuals with ASD without any other co-existing psychiatric disorder are in clear minority ( 5 , 6 ). DSM-5 subtypes ASD according to if the condition is: (a) with or without accompanying intellectual impairment, (b) with or without accompanying language impairment (c) associated with a known medical or genetic condition or environmental exposure, (d) associated with another neurodevelopmental, mental or behavioural disorder and (e) associated with catatonia ( 1 ).…”

“…ASD is associated with several comorbid psychiatric and physical conditions (4)(5)(6). However, the reported prevalence rates vary widely between studies, likely related to the clinical and pathogenetic heterogeneity of ASD (4).…”

“…One recent meta-analysis estimated the lifetime prevalence of ADHD amongst patients with ASD to be approximately 40% ( 7 ), however, depression, obsessive-compulsive disorder and anxiety are also common ( 6 ), in addition to gender dysphoria ( 8 ). Physical comorbidities e.g., sleep related problems, epilepsy, sensory impairments, atopy, autoimmune conditions, clumsiness, and obesity are also frequently reported ( 5 ). Due to the dearth of studies and/or studies with small or highly selective samples, the evidence is limited for other comorbidities ( 5 ).…”

“…Physical comorbidities e.g., sleep related problems, epilepsy, sensory impairments, atopy, autoimmune conditions, clumsiness, and obesity are also frequently reported ( 5 ). Due to the dearth of studies and/or studies with small or highly selective samples, the evidence is limited for other comorbidities ( 5 ). Knowledge about comorbidities is important, given that this may provide clues to underlying aetiological factors ( 4 ).…”

“It’s all about knowing the young person”: Best practice in coaching autistic athletes

“…Autism is a neurodevelopmental condition characterised by difficulties in social communication/social interaction, and restricted/repetitive patterns of behaviour, interests or activities including sensory sensitivities (American Psychiatric Association, 2013). Alongside these core diagnostic features, many autistic individuals find aspects of everyday activities more challenging (Volkmar, Jackson, & Hart, 2017) and are at greater risk of experiencing physical health conditions (Rydzewska, Dunn, & Cooper, 2020), mental health conditions (Lai et al, 2019), and motor skills deficits (Licari et al, 2019). Co-occurrence of autism and ID is common with a recent whole population study in Scotland reporting 21.7% of people with ID also being autistic (Dunn, Rydzewska, MacIntyre, Rintoul, & Cooper, 2019).…”