Children with autism spectrum disorder (ASD) and comorbid pediatric bipolar disorder (PBD) follow a highly episodic progression through manic episodes, phases of subsyndromal symptoms, and euthymic periods, according to a study published in the Journal of Autism and Developmental Disorders.
ASD usually occurs with at least 1 additional disorder. This study sought to describe the clinical features of comorbid pediatric bipolar disorder in children with ASD, with a secondary aim of comparing these clinical features with those of ASD with no affective disorder.
Forty patients age 6 to 17 with both ASD and PBD under treatment at the Ondokuz Mayıs University Medical Faculty Health Application and Research Center Child and Adolescent Mental Health and Diseases Clinic in Turkey made up the study group. The control group included 40 patients with ASD disorder who had experienced no previous affective episodes. Of these 80 children with a mean age of 12.36 ± 2.93 years, 12.5% were girls (n=10) and 87.5% were boys (n=70). The only significant sociodemographic difference between the groups was that children with ASD or PBD received a higher level of special education.
The Autism Behavior Checklist (ABC) and Aberrant Behavior Checklist (ABCL) were administered twice for the PBD+ASD group, for both euthymic and episodic periods. The ABC scores were significantly higher in the episodic periods compared with the euthymic periods, especially within the subcategories of social and adaptive skills, body and object use, and social relating.
No difference was indicated between ABC scores of the study group during euthymic periods compared with those of the control group.
The ABCL scores of the PBD+ASD group showed significantly elevated clinical impairment during episodic periods compared with euthymic periods, although no significant difference was indicated between ABCL scores of the study group during euthymic periods compared with those of the control group. Within the study group, 56.4% experienced manic episodes only.
No psychotic characteristics were identified in the subjects of either group.
Goal-directed agitation and irritability were found to be symptoms of mania in all ASD+PBD participants, as 92.5% showed increased risky behavior and distractibility, 90% showed decreased sleep, 82.5% showed over-talkativeness, and increased stereotypic behavior and obsession appeared in 62.5% and 60% of cases, respectively.
“No variation was determined in our study in terms of ASD symptoms and problem behavior between euthymic periods in children with PBD+ASD and control ASD subjects”, the authors concluded.
Sapmaz D, Baykal S, Akbaş S. The clinical features of comorbid pediatric bipolar disorder in children with autism spectrum disorder [published online March 21, 2018]. J Autism and Dev Disord. doi: 10.1007/s10803-018-3541-x