Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study

Stéphanie Miot; Tasnime Akbaraly; Cecile Michelon; Sylvie Couderc; Sophie Crepiat; Julie Loubersac; Marie-Christine Picot; Éric Pernon; Véronique Gonnier; Claude Jeandel; Hubert Blain; Amaria Baghdadli

doi:10.3389/fpsyt.2019.00617

Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study

Front Psychiatry. 2019 Sep 19:10:617. doi: 10.3389/fpsyt.2019.00617. eCollection 2019.

Authors

Stéphanie Miot^{1

2

3}, Tasnime Akbaraly^{2

4

5}, Cecile Michelon², Sylvie Couderc², Sophie Crepiat², Julie Loubersac², Marie-Christine Picot⁶, Éric Pernon², Véronique Gonnier², Claude Jeandel³, Hubert Blain³, Amaria Baghdadli^{1

2}

Affiliations

¹ CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.
² Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.
³ Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.
⁴ MMDN, Univ. Montpellier, EPHE, INSERM, U1198, Montpellier, France.
⁵ Department of Epidemiology and Public Health, University College London, London, United Kingdom.
⁶ Biostatistic Department, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.

Abstract

Background: Autism spectrum disorder (ASD) is an early-onset and lifelong neurodevelopmental condition frequently associated with intellectual disability (ID). Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. Objectives: To determine the comorbidity burden and its association with distinct clinical presentation in terms of ASD severity, adaptive skills, level of autonomy, and drug exposure in a well-phenotyped sample of individuals with ASD-ID-the EFAAR (Frailty Assessment in Ageing Adults with Autism Spectrum and Intellectual Disabilities) cohort. Methods: A total of 63 adults with ASD-ID, with a mean age of 42.9 ± 15.1 years, were recruited from 2015 to 2017 from nine specialized institutions. They underwent detailed clinical examinations, including screening for comorbidities, ASD severity [Childhood Autism Rating Scale (CARS)], adaptive functioning [Vineland Adaptive Behavior Scale II (VABS-II)], autonomy [activities of daily living (ADLs)], and drug use [polypharmacy and the Drug Burden Index (DBI)]. The comorbidity burden was evaluated using the Cumulative Illness Rating Scale (CIRS-G) and its sub-scores [the severity index (CIRS-SI) and severe comorbidity (CIRS-SC)]. Results: We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy. Conclusion: The severity of the comorbidity burden associated with premature ageing in adults with ASD and ID highlight their crucial need of personalized medical care.

Keywords: CIRS; ageing; autism spectrum disorder; comorbidity burden; intellectual disability.