Difficulties in Diagnosing a Psychiatric Comorbidity

Diagnostic challenges are primarily due to the difficulties that individuals with AS/HFA have in “processing and describing their own feelings and emotions.” Clinical information is often obtained through interviewing family members or caregivers. Additionally, the symptoms may be masked by those typical of AS/HFA. For example, a sudden decrease in repetitive and obsessive behaviors of AS may be a manifestation of depressive symptoms, or an improvement in one of the diagnostic dimensions of AS itself.

There are currently no scales specifically designed to evaluate psychiatric comorbidity in persons with ASDs, as most psychometric instruments have been designed and standardized to spot symptom clusters in the general population. However, the Children’s Yale-Brown Obsessive Compulsive Scales (CYBOCS),16 modified for developmental disorders, has been validated as highly reliable. Although it was developed for low-functioning participants, it can be modified for higher-functioning individuals and may be useful in diagnosing OCD comorbidity. Other existing tools may also be successfully modified for use in reliably diagnosing AS/HFA.

The authors conclude that “an effort should be made to better understand the needs of AS/HFA children in school and family environments, to avoid feelings of low self-esteem and distress, socially inappropriate behaviors, anxiety and other externalizing or internalizing problems.” They add that “proper recognition” of psychiatric comorbidities is “necessary to allow for a more appropriately targeted treatment.”

Continue Reading


1. Simonoff E, Pickles A, Charman T, et al. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity and associated factors in a population-based sample. J Amer Acad Child Adoles Psychiatry. 2008;47(8):921-929.

2. Ryden E, Bejerot S. Autism spectrum disorders in an adult psychiatric population. A naturalistic cross-sectional controlled study. Clin Neuropsychiatry. 2008;5(1):13-21.

3. Ghaziuddin M, Zafar S. Psychiatric comorbidity of adults with autism spectrum disorders. Clin Neuropsychiatry. 2008;5(1):9-12.

4. Ghaziuddin M. A Family History Study of Asperger Syndrome. J Autism Dev Disord. 2005;35(2):177–182.

5. Mazzone L, Ruta L, Reale L. Psychiatric comorbidities in Asperger syndrome and high functioning autism: diagnostic challenges. Ann Gen Psychiatry. 2012;11(1):16.

6. Russell AJ, Mataix-Cols D, Anson M, Murphy DG. Obsessions and compulsions in Asperger syndrome and high-functioning autism. Br J Psychiatry. 2005;186:525–528.

7. Cook EH, Leventhal BL. Autistic disorder and other pervasive developmental disorders. Child Adolesc Psychiatr Clin N Am. 1995;4(2):381–399.

8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Text Revision (DSM-IV-TR), Washington, DC; 2000.

9. Halbfinger, DM. A Gunman, Recalled as Intelligent and Shy, Who Left Few Footprints in Life. Available at: http://www.nytimes.com/2012/12/15/nyregion/adam-lanza-an-enigma-who-is-now-identified-as-a-mass-killer.html?_r=0. Accessed: December 27, 2012.

10. Green J, Gilchrist A, Burton D, Cox A. Social and Psychiatric Functioning in Adolescents with Asperger Syndrome Compared with Conduct Disorder. J Autism Dev Disord. 2000;30(4):279–293.

11. Newman SS, Ghaziuddin M. Violent crime in Asperger syndrome: the role of psychiatric comorbidity. J Autism Dev Disord. 2008;38(10):1848–1852.

12. Baron-Cohen S. An assessment of violence in a young man with Asperger’s syndrome. J Child Psychol Psychiatry. 1988;29(3):351–360.

13. Haskins BG, Silva JA. Asperger’s disorder and criminal behavior: forensic- psychiatric considerations. J Am Acad Psychiatry Law. 2006;34(3):374–384.

14. Mouridsen SE, Rich B, Isager T, Nedergaard NJ. Pervasive developmental disorders and criminal behavior: a case control study. Int J Offender Ther Comp Criminol. 2008;52(2):196–205.

15. Barry-Walsh JB, Mullen PE: Forensic aspects of Asperger’s Syndrome. J Forensic Psychiatry Psychol. 2004;15:96–107.

16. Scahill L, McDougle CJ, Williams SK, et al. Children’s Yale-Brown Obsessive Compulsive Scale Modified for Pervasive Developmental Disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(9):1114-1123.