Children With Autism, ADHD at Increased Risk for Anxiety, Mood Disorders

According to findings published in Pediatrics, children with both autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have an increased risk for anxiety and mood disorders.

Researchers performed a cross-sectional study of 3319 children aged 6 to 17 years with ASD, of whom 1503 (45.3%) reported a diagnosis of or treatment for ADHD. Primary outcome measures were professional diagnoses or treatment of anxiety disorder or mood disorder by parent report; secondary measures were population demographics, report of intellectual disability, and ASD severity score by standardized questionnaire. The cohort was largely boys (82.9%), white (87.2%), and non-Hispanic (92.4%), with a mean age of 10.3 years.

Of the children, 1025 (30.8%) were reported to have an anxiety disorder, 532 (16.0%) were reported to have a mood disorder, and 649 (19.5%) were reported to have intellectual disability. Comorbid ADHD increased with age (P <.001) and was associated with increased ASD severity (P <.001). Per a generalized linear model, children with ASD and ADHD had an increased risk for both anxiety disorders (adjusted relative risk 2.20; 95% CI, 1.97-2.46) and mood disorders (adjusted relative risk 2.72; 95% CI, 2.28-3.24) compared with children with ASD alone. Increasing age was the most significant contributor for anxiety and mood disorders (both P <.001) for all children in the cohort, with a higher risk for both in the adolescent group compared with the grade school-aged group. 

The absence of report of intellectual disability was a significant contributor for mood disorder in both grade school-aged children (P =.041) and adolescents (P =.001), although not for anxiety disorder. Sex, race, and ethnicity were not found to be significant predictive factors in any analysis.

That the study questionnaires required internet access may have biased the cohort toward participants of higher socioeconomic status; as such, findings should be extrapolated with care. However, recognizing the increased risk for mood disorders in children with ASD and ADHD may be useful for clinicians and parents in developing proper screening and treatment strategies. 

Reference

Gordon-Lipkin E, Marvin AR, Law JK, Lipkin PH. Anxiety and mood disorder in children with autism spectrum disorder and ADHD. Pediatrics. 2018;141(4):e20171377.