1. Systematic reviews and meta-analyses of evidence on comorbid health conditions in people with autism spectrum disorder:
A systematic review
Ewelina Rydzewska, Kirsty Dunn, Christopher Gillberg, Sally-Ann Cooper
University of Glasgow, Institute of Health and Wellbeing
Introduction
People with autism spectrum disorder (ASD) experience a wide range of comorbid health problems, some of which may have different prevalence compared with the general population.
Since health problems can significantly affect quality of life, it is important to know how common they are in people with ASD.
Methods
PsycINFO, Scopus, CINAHL, Medline and Cochrane were searched
limited to sources published in English between January 2005 and July 2016
search terms: ‘autis*’ OR ‘pervasive developmental disorder’ OR ‘Asperger*’ OR ‘ASD’
animal, brain-imaging or genetic studies and reviews of intervention and treatment studies on the core symptoms of autism or comorbid health conditions were excluded
quality of all included papers reviewed using a tool for Assessing the Methodological Quality of Systematic Reviews (AMSTAR)
Aim
The aim was to identify and systematically review existing systematic reviews and meta-analyses of evidence on co-occurring health conditions.
Research questions
How common are co-occurring health needs of people with ASD?
Are specific co-occurring health needs in people with ASD more prevalent than in the general population?
Are there gaps in the evidence base on co-occurring health needs in people with ASD?
Results
Flow chart of reviewed articles
Physical health
standardised mortality rate is reported as 2.8; higher SMR for females and learning disabilities or epilepsy related deaths, and accidental deaths from drowning, suffocation, cancer, respiratory, nervous, sensory, and circulatory diseases
life expectancy at 65 is >3 years shorter than the general population
epilepsy is much more common than for the general population, especially in groups with additional learning disabilities, and for women
sleep disorders are reported in 45% of adults
Type II diabetes risk is higher for antipsychotic-exposed youth, but lower in antipsychotic-exposed youth with ASD
gastrointestinal problems, including general symptoms, diarrhoea, constipation and abdominal pain seem to be more common than for comparison groups of typically developing children and youth
inconclusive findings on peripheral hearing loss, oral health and cancer
atopy, such as dermatitis, allergic rhinitis, and asthma may be more common
Mental health
depression (4-34%), bipolar disorder (6-21%) and suicidal ideation (31-50%) appear to be more common than in the general population
anxiety appears to occur more commonly than expected, and may be more common in girls than boys
findings on schizophrenia are inconclusive
findings regarding ASD prevalence in eating disorders are inconclusive
PsycINFO
407
MEDLINE
2,485
Scopus
758
Records identified
3,964
Title and abstract reviewed
3,404
Full papers read 97
Included 24
Did not meet inclusion criteria 73
3,307
Duplicates removed
560
CINAHL
211
Cochrane
103
Limitations of literature
Lack of information on:
assessment and operationalisation of ASD and comorbidities
samples recruitment
Inconsistent results reported due to:
varying study designs
different source populations
participant characteristics
small or highly selective samples
Conclusions
prevalence of some mental (e.g. mood and anxiety disorders) and physical health conditions (e.g. epilepsy and gastrointestinal problems) seems to be higher in people with ASD
heterogeneous methodological approaches and sample characteristic often preclude meaningful pooling of findings
there is a need for more robust research to draw comparisons between specific health needs of people with and without ASD
References (full list available on request): Amiet et al. 2008; Bartolomé-Villar et al. 2016; Beers et al. 2014; Billeci et al. 2015; Catala-Lopez et al. 2014; Elrod and Hood 2015; Galling et al. 2016; Hannon and Taylor 2013; Huke et al. 2013; McElhanon et al. 2014; Padgett et al. 2010; Perkins and Berkman 2012; Reilly et al. 2013; Rubenstein et al. 2015; Segers and Rawana 2014; Skokauska and Gallagher 2009; Spain et al. 2016; Stewart et al. 2006; Su et al. 2016; van de Wouw et al. 2012; Vannucchi et al. 2014; van Steensel et al. 2011; White et al. 2009; Woolfenden et al