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.”


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