Module 3: Behavioral Symptoms & Psychiatric Comorbidity

Learning Objectives for Module 3:
  1. Introduce and identify key aspects of psychiatric evaluation and treatment (i.e., psychosocial, psychopharmacology) of youth with autism spectrum disorder who are experiencing comorbid psychological challenges, including depression, anxiety, obsessive compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), psychosis, and trauma (including bullying)
  2. Introduce and identify key aspects of psychiatric evaluation and treatment (i.e. psychosocial,psychopharmacology) of youth with autism spectrum disorder experiencing comorbid behavioral challenges, including self-injurious behavior (SIB) and aggression.
 
Module 3 PowerPoint Slides:
This module includes a video with general tips from Dr. Rubin, Dr. Fortuna, and Dr. Spencer for psychiatric treatment of youth with ASD.

This module includes a video with tips for trainees from Dr. Rubin, Dr. Fortuna, and Dr. Spencer for psychiatric treatment of youth with ASD.

This module includes a video by Dr. Andrea Spencer, MD on comorbidity with ASD.

This module includes a video by Dr. Lisa Fortuna, MD MPH on assessment and treatment of transition age youth with ASD.

Gadke, D. L., McKinney, C., & Oliveros, A. (2016). Autism spectrum disorder symptoms and comorbidity in emerging adults. Child Psychiatry & Human Development, 47(2), 194-201.

Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., … & Biederman, J. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40(11), 1361-1370.

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2(3), 217-250.

Ketelaars, C., Horwitz, E., Sytema, S., Bos, J., Wiersma, D., Minderaa, R., & Hartman, C. A. (2008). Brief report: Adults with mild autism spectrum disorders (ASD): Scores on the autism spectrum quotient (AQ) and comorbid psychopathology. Journal of Autism and Developmental Disorders, 38(1), 176-180.

Kohane, I. S., McMurry, A., Weber, G., MacFadden, D., Rappaport, L., Kunkel, L., … & Churchill, S. (2012). The co-morbidity burden of children and young adults with autism spectrum disorders. PloS one, 7(4), e33224.

Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(6), 1916-1930.

Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., … & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849-861.

Mannion, A., & Leader, G. (2013). Comorbidity in autism spectrum disorder: A literature review. Research in Autism Spectrum Disorders, 7(12), 1595-1616.

Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28(4), 341-352.

Stadnick, N., Chlebowski, C., Baker-Ericzén, M., Dyson, M., Garland, A., & Brookman-Frazee, L. (2016). Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. Autism, 21(7), 841-851.

ADHD:

Antshel, K. M., Zhang-James, Y., & Faraone, S. V. (2013). The comorbidity of ADHD and autism spectrum disorder. Expert Review of Neurotherapeutics13(10), 1117-1128.

Davis, N. O., & Kollins, S. H. (2012). Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics9(3), 518-530.

Leitner, Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children–what do we know?. Frontiers in Human Neuroscience8.

Miodovnik, A., Harstad, E., Sideridis, G., & Huntington, N. (2015). Timing of the diagnosis of attention-deficit/hyperactivity disorder and autism spectrum disorder. Pediatrics136(4), e830-e837.

Sokolova, E., Oerlemans, A. M., Rommelse, N. N., Groot, P., Hartman, C. A., Glennon, J. C., … & Buitelaar, J. K. (2017). A causal and mediation analysis of the comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders, 1-10.

Van Steensel, F. J., Bögels, S. M., & de Bruin, E. I. (2013). Psychiatric comorbidity in children with autism spectrum disorders: A comparison with children with ADHD. Journal of Child and Family Studies22(3), 368-376.

 Anxiety:

Grondhuis, S. N., & Aman, M. G. (2012). Assessment of anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders6(4), 1345-1365.

Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science and Practice19(4), 323-347

Kreiser, N. L., & White, S. W. (2014). Assessment of social anxiety in children and adolescents with autism spectrum disorder. Clinical Psychology: Science and Practice21(1), 18-31.

MacNeil, B. M., Lopes, V. A., & Minnes, P. M. (2009). Anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders3(1), 1-21.

Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of anxiety disorders12(4), 387-393.

van Steensel, F. J., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302.

White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216-229.

Depression:

Greenlee, J. L., Mosley, A. S., Shui, A. M., Veenstra-VanderWeele, J., & Gotham, K. O. (2016). Medical and behavioral correlates of depression history in children and adolescents with autism spectrum disorder. Pediatrics137(Supplement 2), S105-S114.

Matson, J. L., & Williams, L. W. (2014). Depression and mood disorders among persons with Autism Spectrum Disorders. Research in Developmental Disabilities, 35(9), 2003-2007.

Sterling, L., Dawson, G., Estes, A., & Greenson, J. (2008). Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(6), 1011-1018.

Vannucchi, G., Masi, G., Toni, C., Dell, L., Erfurth, A., & Perugi, G. (2014). Bipolar disorder in adults with Asperger׳ s Syndrome: A systematic review. Journal of Affective Disorders, 168, 151-160.

Vickerstaff, S., Heriot, S., Wong, M., Lopes, A., & Dossetor, D. (2007). Intellectual ability, self-perceived social competence, and depressive symptomatology in children with high-functioning autistic spectrum disorders. Journal of Autism and Developmental Disorders37(9), 1647-1664.

OCD:

Meier, S. et. al. (2015) Obsessive-Compulsive Disorder and Autism Spectrum Disorders: Longitudinal and Offspring Risk. PLOS One 10(11).

Ruta, L., Mugno, D., D’Arrigo, V. G., Vitiello, B., & Mazzone, L. (2010). Obsessive–compulsive traits in children and adolescents with Asperger syndrome. European Child & Adolescent Psychiatry19(1), 17.

Scahill, L., Dimitropoulos, A., McDougle, C., J., Aman, M. G., Feurer, I. D., McCracken, J. T., … & Hallett, V. (2014). Children’s Yale-Brown Obsessive Compulsive Scale in Autism Spectrum Disorder: Component structure and correlates of symptom checklist

Psychosis:

Barneveld, P. S., de Sonneville, L., van Rijn, S., van Engeland, H., & Swaab, H. (2013). Impaired response inhibition in autism spectrum disorders, a marker of vulnerability to schizophrenia spectrum disorders?. Journal of the International Neuropsychological Society, 19(06), 646-655.

Cochran, D. M., Dvir, Y., & Frazier, J. A. (2013). ‘Autism-plus’ spectrum disorders: Intersection with psychosis and the schizophrenia spectrum. Child And Adolescent Psychiatric Clinics Of North America, 22(4), 609-627.

Kastner, A., Begemann, M., Michel, T. M., Everts, S., Stepniak, B., Bach, C., … & Ehrenreich, H. (2015). Autism beyond diagnostic categories: Characterization of autistic phenotypes in schizophrenia. BMC Psychiatry15(1), 115.

Kincaid, Debbie L. (2017). What is the prevalence of autism spectrum disorder and ASD traits in psychosis? A systematic review. Psychiatry Research, 250, 99-105.

Kyriakopoulos, M., Stringaris, A., Manolesou, S., Radobuljac, M. D., Jacobs, B., Reichenberg, A., … & Frangou, S. (2015). Determination of psychosis-related clinical profiles in children with autism spectrum disorders using latent class analysis. European Child & Adolescent Psychiatry24(3), 301-307.

Larson, F. V., Wagner, A. P., Jones, P. B., Tantam, D., Lai, M. C., Baron-Cohen, S., & Holland, A. J. (2017). Psychosis in autism: Comparison of the features of both conditions in a dually affected cohort. The British Journal of Psychiatry, 210(4), 269-27.

Mandell, D. S., Lawer, L. J., Branch, K., Brodkin, E. S., Healey, K., Witalec, R., … & Gur, R. E. (2012). Prevalence and correlates of autism in a state psychiatric hospital. Autism, 16(6), 557-567.

Rinaldi, Jacquet, & Lefebvre. (2015). Neurocognitive characteristics of psychotic symptoms in young adults with high functioning autism. Research in Autism Spectrum Disorders, 17, 135-141.

Rapoport, J., Chavez, A., Greenstein, D., Addington, A., & Gogtay, N. (2009). Autism spectrum disorders and childhood-onset schizophrenia: Clinical and biological contributions to a relation revisited. Journal of the American Academy of Child & Adolescent Psychiatry48(1), 10-18.

Selten, J. P., Lundberg, M., Rai, D., & Magnusson, C. (2015). Risks for nonaffective psychotic disorder and bipolar disorder in young people with autism spectrum disorder: A population-based study. JAMA Psychiatry72(5), 483-489.

Simoncini, M., Miniati, M., Vanelli, F., Callari, A., Vannucchi, G., Mauri, M., & Dell’Osso, L. (2014). Lifetime autism spectrum features in a patient with a psychotic mixed episode who attempted suicide. Case Reports in Psychiatry2014.

Self-Injurious Behavior/Aggression:

Carroll, D., Hallett, V., McDougle, C. J., Aman, M. G., McCracken, J. T., Tierney, E., … & Swiezy, N. (2014). Examination of aggression and self-injury in children with autism spectrum disorders and serious behavioral problems. Child and Adolescent Psychiatric Clinics of North America, 23(1), 57-72.

Heeramun, R., Magnusson, C., Gumpert, C. H., Granath, S., Lundberg, M., Dalman, C., & Rai, D. (2017). Autism and convictions for violent crimes: population-based cohort study in Sweden. Journal of the American Academy of Child & Adolescent Psychiatry56(6), 491-497.

Trauma:

Im, David S. (2016). Trauma as a contributor to violence in autism spectrum disorder. Journal of the American Academy of Psychiatry and the Law Online, 44(2), 184-192.

Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal Of Autism And Developmental Disorders, 45(11), 3475-3486.

Pfeffer, R. D. (2016). Childhood Victimization in a National Sample of Youth with Autism Spectrum Disorders. Journal of Policy and Practice in Intellectual Disabilities13(4), 311-319.

Taylor, J. L., & Gotham, K. O. (2016). Cumulative life events, traumatic experiences, and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. Journal of Neurodevelopmental Disorders8(1), 28.

Valenti, M., Ciprietti, T., Di Egidio, C., Gabrielli, M., Masedu, F., Tomassini, A. R., & Sorge, G. (2012). Adaptive response of children and adolescents with autism to the 2009 earthquake in L’Aquila, Italy. Journal of Autism and Developmental Disorders42(6), 954-960.Westphal,

Alexander. (2016). Trauma and violence in autism. Journal of the American Academy of Psychiatry and the Law Online, 44(2), 198-199.

Evidence-Informed Mental Health Interventions:

Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders37(10), 1842-1857.

Donoghue, K., Stallard, P., & Kucia, J. (2011). The clinical practice of cognitive behavioural therapy for children and young people with a diagnosis of Asperger’s syndrome. Clinical Child Psychology and Psychiatry16(1), 89-102.

Keehn, R. H. M., Lincoln, A. J., Brown, M. Z., & Chavira, D. A. (2013). The Coping Cat program for children with anxiety and autism spectrum disorder: A pilot randomized controlled trial. Journal of Autism and Developmental Disorders43(1), 57-67.

McConachie, H., McLaughlin, E., Grahame, V., Taylor, H., Honey, E., Tavernor, L., … & Le Couteur, A. (2014). Group therapy for anxiety in children with autism spectrum disorder. Autism18(6), 723-732.

Narendorf, S. C., Shattuck, P. T., & Sterzing, P. R. (2011). Mental health service use among adolescents with an autism spectrum disorder. Psychiatric Services62(8), 975-978.

Reaven, J., Blakeley‐Smith, A., Culhane‐Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high‐functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry53(4), 410-419.

Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology37(1), 105-130.

Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry46(11), 1152-1160.

Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry50(3), 224-234.

Psychopharmacology Treatment:

Andari, E., Duhamel, J. R., Zalla, T., Herbrecht, E., Leboyer, M., & Sirigu, A. (2010). Promoting social behavior with oxytocin in high-functioning autism spectrum disorders. Proceedings of the National Academy of Sciences107(9), 4389-4394.

Arnold, L. E., Aman, M. G., Cook, A. M., Witwer, A. N., Hall, K. L., Thompson, S., & Ramadan, Y. (2006). Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. Journal of the American Academy of Child & Adolescent Psychiatry45(10), 1196-1205.

Brodkin, E. S., McDougle, C. J., Naylor, S. T., Cohen, D. J., & Price, L. H. (1997). Clomipramine in adults with pervasive developmental disorders: a prospective open-label investigation. Journal of Child and Adolescent Psychopharmacology7(2), 109-121.

Coskun, M., & Mukaddes, N. M. (2008). Mirtazapine treatment in a subject with autistic disorder and fetishism. Journal of child and adolescent psychopharmacology18(2), 206-209.

Fankhauser, M. P., Karumanchi, V. C., German, M. L., Yates, A., & Karumanchi, S. D. (1992). A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism. The Journal of Clinical Psychiatry.

Franco, I., Von Gontard, A., De Gennaro, M., & members of the International Children’s Continence Society. (2013). Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children’s Continence Society. Journal of Pediatric Urology9(2), 234-243.

Galli-Carminati, G. M., Deriaz, N., & Bertschy, G. (2009). Melatonin in treatment of chronic sleep disorders in adults with autism: a retrospective study. Swiss Medical Weekly139(19-20), 293-296.

Geier, D. A., Kern, J. K., Davis, G., King, P. G., Adams, J. B., Young, J. L., & Geier, M. R. (2011). A prospective double-blind, randomized clinical trial of levocarnitine to treat autism spectrum disorders. Medical science monitor: international medical journal of experimental and clinical research17(6), PI15.

Ghanizadeh, A. (2012). Atomoxetine for treating ADHD symptoms in Autism: A systematic review. Journal of Attention Disorder, 17(8), 635-640.

Hardan, A. Y., Fung, L. K., Libove, R. A., Obukhanych, T. V., Nair, S., Herzenberg, L. A., … & Tirouvanziam, R. (2012). A randomized controlled pilot trial of oral N-acetylcysteine in children with autism. Biological Psychiatry71(11), 956-961.

Hellings, J. A. (1999). Psychopharmacology of mood disorders in persons with mental retardation and autism. Developmental Disabilities Research Reviews5(4), 270-278.

Hellings, J. A., Weckbaugh, M., Nickel, E. J., Cain, S. E., Zarcone, J. R., Reese, R. M., … & Cook, E. H. (2005). A double-blind, placebo-controlled study of Valproate for aggression in youth with pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology15(4), 682-692.

Hollander, E., Chaplin, W., Soorya, L., Wasserman, S., Novotny, S., Rusoff, J., … & Anagnostou, E. (2010). Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders. Neuropsychopharmacology35(4), 990.

Hollander, E., Dolgoff-Kaspar, R., Cartwright, C., Rawitt, R., & Novotny, S. (2001). An open trial of divalproex sodium in autism spectrum disorders. The Journal of clinical psychiatry.

Hollander, E., Phillips, A., Chaplin, W., Zagursky, K., Novotny, S., Wasserman, S., & Iyengar, R. (2005). A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology30(3), 582.

Hollander, E., Soorya, L., Chaplin, W., Anagnostou, E., Taylor, B. P., Ferretti, C. J., … & Settipani, C. (2012). A double-blind placebo-controlled trial of fluoxetine for repetitive behaviors and global severity in adult autism spectrum disorders. American Journal of Psychiatry169(3), 292-299.

Jaselskis, C. A., COOK JR, E. H., Fletcher, K. E., & Leventhal, B. L. (1992). Clonidine treatment of hyperactive and impulsive children with autistic disorder. Journal of clinical psychopharmacology12(5), 322-327.

Kerbeshian, J., Burd, L., Randall, T., Martsolf, J., & Jalal, S. (1990). Autism, profound mental retardation and atypical bipolar disorder in a 33‐year‐old female with a deletion of 15q12. Journal of Intellectual Disability Research34(2), 205-210.

King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregman, J. D., … & Hirtz, D. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Archives of general psychiatry66(6), 583-590.

Koshes, R. J. (1997). Use of fluoxetine for obsessive-compulsive behavior in adults with autism. The American journal of psychiatry154(4), 578.

McDougle, C. J., Naylor, S. T., Cohen, D. J., Volkmar, F. R., Heninger, G. R., & Price, L. H. (1996). A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Archives of general psychiatry53(11), 1001-1008.

McDougle, C. J., Price, L. H., & Goodman, W. K. (1990). Fluvoxamine treatment of coincident autistic disorder and obsessive-compulsive disorder: a case report. Journal of autism and developmental disorders20(4), 537-543.

Nguyen, M., & Murphy, T. (2001). Mirtazapine for excessive masturbation in an adolescent with autism. Journal of the American Academy of Child & Adolescent Psychiatry40(8), 868-869.

Nikvarz, N., Alaghband-Rad, J., Tehrani-Doost, M., Alimadadi, A., & Ghaeli, P. (2017). Comparing efficacy and side effects of memantine vs. risperidone in the treatment of autistic disorder. Pharmacopsychiatry50(01), 19-25.

Posey, D. J., Guenin, K. D., Kohn, A. E., Swiezy, N. B., & McDougle, C. J. (2001). A naturalistic open-label study of mirtazapine in autistic and other pervasive developmental disorders. Journal of child and adolescent psychopharmacology11(3), 267-277.

Posey, D. J., Kem, D. L., Swiezy, N. B., Sweeten, T. L., Wiegand, R. E., & McDougle, C. J. (2004). A pilot study of D-Cycloserine in subjects with autistic disorder. American Journal of Psychiatry161(11), 2115-2117.

Posey, D. J., Wiegand, R. E., Wilkerson, J., Maynard, M., Stigler, K. A., & McDougle, C. J. (2006). Open-label atomoxetine for attention-deficit/hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology16(5), 599-610.

Malow, B., Adkins, K. W., McGrew, S. G., Wang, L., Goldman, S. E., Fawkes, D., & Burnette, C. (2012). Melatonin for sleep in children with autism: a controlled trial examining dose, tolerability, and outcomes. Journal of Autism and Developmental Disorders42(8), 1729-1737.

Rezaei, V., Mohammadi, M. R., Ghanizadeh, A., Sahraian, A., Tabrizi, M., Rezazadeh, S. A., & Akhondzadeh, S. (2010). Double-blind, placebo-controlled trial of risperidone plus topiramate in children with autistic disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry34(7), 1269-1272.

Steingard, R., & Biederman, J. (1987). Lithium responsive manic‐like symptoms in two individuals with autism and mental retardation. Journal of the American Academy of Child & Adolescent Psychiatry26(6), 932-935.

Stigler, K. A., Posey, D. J., & McDougle, C. J. (2004). Aripiprazole for maladaptive behavior in pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology14(3), 455-463.

Wink, L. K., Plawecki, M. H., Erickson, C. A., Stigler, K. A., & McDougle, C. J. (2010). Emerging drugs for the treatment of symptoms associated with autism spectrum disorders. Expert Opinion on Emerging Drugs15(3), 481-494.

Wink, L. K., Erickson, C. A., Stigler, K. A., & McDougle, C. J. (2011). Riluzole in autistic disorder. Journal of Child and Adolescent Psychopharmacology21(4), 375-379.