Policy Statement on Co-occurring Psychiatric Conditions in Autism Spectrum
and Intellectual Developmental Disorders
Background
Individuals with autism spectrum disorder (ASD) and intellectual developmental disorder (IDD) have higher rates of co-occurring psychiatric conditions than the general population. These conditions, which include attention-deficit/hyperactivity disorder (ADHD), anxiety, psychosis, mood disorders, substance use disorders, suicidal behavior, and catatonia, among others, are associated with high rates of mental health crises, emergency department visits, inpatient psychiatric hospitalizations, and more restrictive placements.
Children with ASD/IDD and co-occurring psychiatric conditions face significant health disparities in both clinical care and research, which has resulted in adverse outcomes and lower quality of life. From a clinical standpoint, there are limited mental health services for this group due to restrictive admission policies to clinics and inpatient psychiatric units, sub-optimal physician training in managing these conditions, and an overall shortage of knowledgeable and skilled providers. The lack of mental health services for this group has led to undue suffering for patients and their families. From a research standpoint, children with ASD/ID are often excluded from studies of child psychopathology in the general population. This approach overlooks the real-world psychiatric comorbidity experienced by children with ASD/IDD and perpetuates a weak evidence-base for the diagnosis and treatment of co-occurring psychiatric conditions in this group. Collectively, the limited access to mental health services and availability of evidence-based mental health treatments for children with ASD/IDD, combined with professional training gaps, has left physicians with insufficient guidance to address co-occurring psychiatric conditions in this group.
Exclusion of individuals with ASD/IDD in clinical care and research is not compatible with the ethical principle of justice, which stipulates that the potential benefits of treatment or research should be applied equally.
In order to optimize traditional care settings to meet the unique clinical need of individuals with ASD/IDD and to support inclusion of individuals with ASD/IDD in child psychopathology research studies, the American Academy of Child and Adolescent Psychiatry (AACAP) recommends:
- Policymakers and health facilities invest in making clinical services more inclusive for individuals with ASD/IDD to reduce healthcare disparities.
- Quality benchmarks such as “focus on developmentally informed care” be an essential component of patient-centered models by accreditation agencies.
- Training requirements in addressing both the core neurodevelopmental features of ASD/IDD and co-occurring conditions be codified in program guidelines for all mental health providers.
- Individuals with ASD/IDD across the lifespan be included in research studies of mental health treatment to promote the development of an evidence base for treatment of individuals with ASD/IDD.
- Federal and state government agencies fund grants and supplements promoting research on participants with ASD/IDD of all ages in studies of mental health treatments. Additional funding would allow appropriate screening and assessment of ASD/IDD and the routine reporting of ASD/IDD severity in demographic information. Such funding would enable data-sharing across research groups to inform conclusions from a sufficiently large population of participants with ASD/IDD.