Undiagnosed autistic traits common in adolescents with substance use disorders

Typically, studies of substance use disorders in autism are conducted in people who have already been diagnosed with autism. We looked at this question from the other side: asking how many people with substance use disorders have autism.

James McKowen, PhD
Suchtheilungsdienst, Massachusetts General Hospital

BOSTON – Researchers at Massachusetts General Hospital (MGH) report that one in five teenagers and young adults who seek treatment for alcohol or drug use may have traits characteristic of previously unrecognized autism spectrum disorder (ASD).

They found that of patients with a mean age of 18.7 years treated in a substance use disorder (SUD) outpatient clinic, 20% had elevated scores on the Social Responsiveness Scale-2 (SRS-2), parents reported or teacher measure that has been shown to reliably identify the presence and severity of social impairments in individuals along the autism spectrum and to distinguish autism from other disorders.

The study, the results of which will be published in The American Journal of Addiction, is the first to examine the prevalence of previously undiagnosed autistic traits in teenagers and young adults with SUD, says lead author James McKowen, PhD, of the Addiction Recovery Management Service at MGH and Harvard Medical School.

“Typically, studies of substance use disorders in autism are conducted in people who already have a diagnosis of autism,” he says. “We looked at this question from the other side and asked how many people with substance use disorders have autism.”

The researchers asked the parents of 69 adolescents who were presenting to a specialized SUD psychiatric outpatient clinic for the first time to fill out the SRS-2 form. The form is designed to measure a person’s social awareness, social cognition (thinking about other people and interactions with them), social communication, social motivation, and limited interests and repetitive behaviors.

They found that although there were few differences between those with elevated autistic trait scores and those with lower, non-autistic scores in terms of demographic or psychiatric factors, the adolescents with higher SRS-2 scores were nearly eight times more likely to have an autistic trait had stimulant use disorder and a five-fold increased risk of opioid use disorder.

The findings underscore the importance of assessing patients in a SUD treatment setting for autistic traits, the researchers write.

“For clinicians, the key takeaway from this study is that we need to get better at screening and certainly training in the presence of autism spectrum disorders, as many clinicians treat substance use disorders but do not have specific developmental training, particularly for issues surrounding autism.” , says McKowen.

“The great benefit for parents is that if you suspect your child has an autism spectrum problem, or if school staff have suggested your child may have autistic traits, you definitely get it checked out and your doctor should let you know if your child has had a prior diagnosis of ASD,” he says.

Researchers are developing a no-cost clinical therapy protocol that may help physicians better address the issues of autistic traits in patients with SUD.

Study co-authors include Diana Woodward, BA, Maura DiSalvo, MPH, Vinod Rao, MD, PhD, Julia Greenbaum, BA, Gagan Joshi, MD, and Timothy E. Wilens, MD, of MGH, and Amy M. Yule, MD, from Boston University School of Medicine and Boston Medical Center.

The study was supported by grants from the Demarest Lloyd, Jr. Foundation.

About Massachusetts General Hospital
Founded in 1811, Massachusetts General Hospital is Harvard Medical School’s original and largest teaching hospital. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations exceeding $1 billion and includes more than 9,500 researchers working in more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 on the list US News & World Report List of “America’s Best Hospitals”.


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