Comorbidities in School-Age Children and Adolescents with Autism in an Ethnically Diverse Population: Brief Report.

Objectives: (1) To examine psychiatric and developmental comorbidities in school-age children and adolescents with Autism in a university-affiliated urban developmental center that serves children with developmental disabilities, and (2) to compare comorbidities by age groups. Methods: Review of all school-age children and adolescents evaluated and diagnosed with autism from 1/2019 to 1/2022. Data included: Demographics (age, gender, race/ethnic group, bilingual English/Spanish households) and other developmental and psychiatric diagnoses besides autism, including language disorder, specific learning disorders (LD), attention-deficit/hyperactivity disorder (ADHD), intellectual disabilities (ID), anxiety disorders (i.e., generalized anxiety disorder, anxiety disorder, unspecified, social anxiety disorder), and depressive disorders (i.e., major depressive disorder, depressive disorder, unspecified). Statistics included chi-square, and nonparametric tests, comorbidities were compared between school-age children and adolescents. Results: Of all children evaluated in that period (n = 599), 119 (20%) were diagnosed with autism, 97 (81%) boys, age 11.8 ± 3 years old, 46 (39%) bilingual English/Spanish households; 65 (55%) were school-age children and 54 (45%) were adolescents (age = 12-18). Of the 119, 115 (96%) presented with one or more co-occurring conditions, including language disorder in 101 (85%), LD in 23 (19%), ADHD in 50 (42%), and ID in 30 (25%). Psychiatric co-occurring conditions included anxiety disorders in 24 (20%) and depressive disorders in 8 (6%). School-age children with autism were more likely to be diagnosed with ADHD combined type (42% vs. 22%, p = 0.04) and language disorders (91% vs. 73%, p = 0.04), whereas adolescents with autism were more likely to be diagnosed with depressive disorders (13% vs. 1%, p = 0.03), with no other differences between the groups. Conclusion: In this urban, ethnically diverse group of children with autism, the vast majority presented with one or more comorbid diagnoses. School-age children were more likely to be diagnosed with language disorder and ADHD, while adolescents were more likely to be diagnosed with depression. Early detection and treatment of co-occurring conditions in autism are necessary.

Pharmacological Treatment of Body Dysmorphic Disorder.

Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one's physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric disorders, including major depressive disorder and autism spectrum disorder. It is currently understood to arise from a combination of biological, psychological, and environmental factors. Treatment of body dysmorphic disorder typically consists of a combination of pharmacotherapy and cognitive behavioral therapy. However, not all patients respond to treatment, and BDD symptoms remain even in those who do respond. This review outlines current pharmacological and neuromodulation treatments for body dysmorphic disorder and suggests directions for future studies of novel treatments such as augmentation with atypical antipsychotics and the use of intranasal oxytocin in cases of body dysmorphic disorder that show residual symptomatology even with tailored monotherapy. There is emerging evidence suggesting that non-invasive neurostimulatory techniques, such as repetitive transcranial magnetic stimulation, may be of value in treatment-resistant cases.