By Dr. Richard Frye, TACA Physician Advisory member
A recent study in The British Journal of Psychiatry examined mortality rates in 27,122 high and low functioning Swedish individuals diagnosed with autism spectrum disorder (ASD) between 1987-2009 and compared these to mortality rates to 2,672,185 randomly selected non-ASD individuals matched on gender, age and county of residence. Individuals with ASD were about 2.6 times more likely to die as compared to the control population with this risk relatively higher in males and lower functioning individuals with ASD. The non-ASD individuals, on average, lived until 70 years of age while individuals diagnosed with ASD lived significantly shorter, on average, until 54 years of age. When examining higher vs lower functioning individuals, lower functioning individuals lived significantly shorter, until, on average, 40 years of age, while higher functioning individuals lived, on average, until 59 years of age.
The study also examined the differences in cause of death between individuals with ASD as compared to controls. Causes included infection, neoplasm, endocrine disease, mental and behavioral disorders, disease of the nervous, cardiovascular, respiratory, digestive and genitourinary systems, congenital malformations and suicide. Except for infection, individuals with ASD demonstrated higher mortality from all of these causes with the greatest difference in mortality rates between ASD and control individuals for causes related to the nervous system, congenital malformations and suicide.
Individuals who were lower functioning demonstrated particularly higher mortality rates related to endocrine, nervous, respiratory systems, mental and behavioral disorders and congenital malformations. The highest increase in mortality in lower functioning individuals with ASD was nervous system disorders with low functioning ASD over 40 times more likely to die from a nervous system disorder as compared to control individuals. Low functioning individuals were also 20 times more likely to die from a mental and behavioral disorder as compared to controls. This should not be a surprise, as we already know that lower functioning individuals with ASD have more nervous system problems such as seizures that continue life long into adulthood and tend to have more behavioral problems requiring treatment with psychoactive medications.
For higher functioning individuals with ASD, mortality due to suicide was 9 times higher than control individuals; probably indicating poorly controlled or undertreated or poorly recognized psychiatric problems.
All of these data point to and confirm the complicated medical nature of ASD. The medical nature of ASD is still not well recognized. Without recognizing the biological basis of ASD, it is not possible to discover and develop new treatments. Treatment are sorely needed as there currently are no FDA approved medical treatments for ASD that targets the core symptoms of ASD or corrects underlying physiological abnormalities. As with any medical disease, the longer it goes untreated, the worse if becomes and the harder it is to treat in the long run.
This study should be a wake up call to the medical community to carefully examine children with ASD so underlying medical abnormalities can be identified and treated early in life, in order to improve long term outcomes. Unfortunately much needed medical research has concentrated on genetics cause of autism rather than addressing physiological disorders association with autism that might be amenable to treatment (see our blog in the Huffington Post) and environmental causes of autism that can lead us to developing prevention strategies (see our review on environmental factors). Some high quality research studies have suggested that some physiological abnormalities may be amenable to treatment (see our recent review) but more research is needed. In addition, more careful recognition and treatment of medical comorbidities in individuals with ASD can not only improve quality of life but also may extent their lifespan. This will improve not only the life of the individuals but also their families.
For Dr. Frye’s complete bio please see http://www.tacanow.org/about-taca/physician-advisory-board/