Characteristics and Co-morbidities of Autism Spectrum Disorder as Predictors of Severity: A National Survey in the United States
Manouchehr Amanat1, Mona Salehi2, Aida Lotfi3, Arham Ahmad4, Sasidhar Gunturu4
1Neurology, 2Psychiatry, Johns Hopkins School of Medicine, 3Jonkoping University School of Health and Welfare, 4Psychiatry, Bronx Care Health System
Objective:

This study aimed to assess the common clinical characteristics of autism spectrum disorder (ASD). In the next step, clinical features associated with the severity of ASD were identified.

Background:
ASD consists of a heterogeneous neurodevelopmental disorders with impairments in social communication, repetitive behaviors, and restricted interests. This condition is associated with several co-morbidities which significantly affect the quality of life. Therefore, individuals with ASD should undergo screening for common co-morbidities to enable early diagnosis and treatment. 
Design/Methods:
Data of National Survey of Children’s Health (NSCH) in the US from 2020 to 2021 were used in this study. We included 79,182 children and adolescents aged between 3 to 18 years for the analysis. The mean age of these individuals was 10.1 (standard deviation: 4.6), and 2,568 (3.2%) had ASD diagnosis. 
Results:

Our analysis showed that ASD is more common in males (78.7%) than females (21.3%). Additionally, ASD was more prevalent among families with lower income levels. We found that 96.4% of patients developed at least one co-morbid condition. The most common neuropsychiatric co-morbidities included developmental delay (64%), behavioral and conduct problems (57.8%) and anxiety (45.7%). The odds of intellectual disability (odds ratio, OR: 5.8), developmental delay (OR: 5.0), Down syndrome (OR: 4.5), epilepsy (OR: 3.4), cerebral palsy (OR: 3.0), vision problems (OR: 2.5), and genetic disorders (OR: 2.3) were significantly higher among severe cases.

Conclusions:

The presence of numerous co-morbidities in individuals with ASD, often linked to increased ASD severity, demonstrates the critical importance of comprehensive screening, early diagnosis, and targeted treatment strategies to enhance the overall health and well-being of these individuals.

10.1212/WNL.0000000000205395