Psychiatric problems in individuals with autism, their parents and siblings

The objective of this paper is to review psychiatric problems in children and adults with autism and related disorders and their first-degree relatives, with a focus on: (1) why they present with psychiatric problems; (2) rates of psychiatric disorders; (3) clinical features important in diagnosis and differential diagnosis; (4) treatment. The data come from published reports of psychiatric problems in individuals with autism, Asperger's disorder, or Pervasive Developmental Disorder Not Otherwise Specified and their relatives and the clinical experience of the author and other experts. Children and adults with autism may present with psychiatric problems because of the core defining features of autism, cognitive impairments, medical disorders, other psychiatric symptoms and disorders, and life experiences related to having autism. The data suggest that depression, anxiety, impairing compulsive behaviours, attentional problems, hyperactivity, and sleep problems occur commonly in individuals with autism. Tics and Tourette's disorder appears to occur in a substantial minority. Schizophrenia occurs infrequently. Clinical features of autism and the inapplicability of subjective diagnostic criteria make the diagnosis of other psychiatric disorders difficult in many autistic individuals. Rates of major depression and social phobia are increased in first-degree relatives of autistic probands. The burden of raising an autistic child may also contribute to the development of psychiatric problems in parents and siblings. Future studies need to determine if the risk of developing particular psychiatric disorders and problems is truly increased in individuals with autism and related disorders above the risk in the general population and in individuals with other developmental disorders. If risk is increased, potential risk factors of a genetic, neurologic, cognitive, and environmental nature will need to be identified and understood. In order to measure risk and identify risk factors, reliable, valid methods for diagnosing psychiatric disorders and problems in autistic children and adults must be developed.