New research finds a striking imbalance in diagnosis rates for common debilitating health conditions, such as anxiety and depression, in autistic people.
University College London calls for better detection of common health conditions in their new study published in The Lancet Regional Health – Europe. Autism is a spectrum condition and affects people in different ways, such as struggling with communication, repetitive behaviour and extreme anxiety. In new findings, researchers found that health conditions may be underdiagnosed in autistic people.
Analysing data from over 20,000 people
The team analysed whether people with autism experience similar rates of five common mental health conditions (anxiety, depression, self-harm, harmful alcohol use, and substance use) /and three common physical health conditions (migraine, neck/back pain, and gynaecological issues), compared to people of the same age and sex who had not been diagnosed as autistic.
Anonymised data from UK GP practices was used to study individuals diagnosed with autism between 2000 and 2019. They studied 15,675 people diagnosed as autistic without a learning disability and 6,437 participants diagnosed as autistic with a learning disability. These groups were compared with people of the same age and sex who had not been diagnosed as autistic.
Unmet support needs for autistic people
The research suggested that some health conditions are more common in autistic people; however, GP records of diagnoses did not reflect this, suggesting that autistic people are less likely to receive diagnoses for common health conditions.
Furthermore, autistic adults were about twice as likely to have a GP record of self-harm, highlighting how autistic people have greater unmet mental health support needs compared to the general population.
Autistic adults without a learning disability were 80-90% more likely to receive a new diagnosis of anxiety or depression compared to the general population. This figure was less than expected based on previous mental health surveys, which show certain mental health conditions appear to be more prevalent in autistic than non-autistic people. For example, one survey* found that older adults self-reporting high autism characteristics in the UK were more than seven times as likely to have anxiety and five times as likely to report self-harm with suicidal intent.
Furthermore, autistic people with a learning disability were diagnosed less frequently than the general population with conditions including depressive disorders, harmful alcohol use, migraine, and neck or back pain. Previous research shows these conditions are more likely to be common in autistic people with learning disabilities than in the general population.
Lead author, Dr Elizabeth O’Nions (UCL Psychology & Language Sciences and Bradford Institute for Health Research), said: “Autistic adults, particularly those with a learning disability, often find it hard to communicate with GPs about how they are feeling. Some people with a learning disability may also not recognise the need to tell someone about a health condition. This means that conditions where signs can’t be readily observed, and a person must describe what has been happening to them may go undiagnosed.
“Different types of evidence and more thorough investigations may be needed to ensure that autistic people receive equal access to high-quality care.”
Corresponding author, Professor Josh Stott (UCL Psychology & Language Sciences), said: “We believe that improved detection of health problems in autistic people, particularly those with learning disabilities, should be a clinical and policy priority to reduce health inequalities.
“Untreated mental and physical health conditions are one potential mechanism that may contribute to the known premature mortality and higher suicide rate experienced by autistic people.”
Limitations of the study include the large proportion of undiagnosed autistic adults in the UK, meaning that the results of this study that focused on those with a diagnosis only may not be generalised to all autistic people.
Dr O’Nions said: “We can only infer that our results reflect under-diagnosis of common conditions by comparing our results to other studies, which were conducted in different settings. More work is needed to try to actively identify how common these health conditions really are in autistic and non-autistic people to provide more conclusive evidence that they are under-diagnosed.”
