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Egyptian children with autism spectrum disorders: risk factors and comorbidity in relation to disease severity

Background Autism spectrum disorders (ASDs) represent a group of neurodevelopmental disorders characterized by impaired reciprocal socialization and communication, often accompanied with stereotyped ritualistic behavior. To date, no clear data could explain the dramatic worldwide increase in the incidence of ASD during the last two decades. It is suggested that some environmental factors besides a genetic predisposition leads to the disease. In addition, the disease is known to be associated with other psychiatric comorbidities. Aim The current study aimed to assess the incidence of psychiatric comorbidity present in those children and to relate the findings to the severity of the disease. Patients and methods The current study included 40 children (27 boys and 13 girls), with ages ranging from 3 to 11 years, and diagnosed with ASDs on the basis of the DSM-IV-TR criteria. Patients were divided to three groups according to their score on Gilliam Autism Rating Scale: mild ASD (10 cases); moderate ASD (11 cases), and severe ASD (19 cases). Data were collected through clinical psychiatric interview, Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), the Gilliam Autism Rating Scale, Vineland Adaptive Behavior Scales, and a scale for measuring family socioeconomic status for health research in Egypt. Results The present study demonstrated that 72.5% of the cases presented in families with middle socioeconomic status, which are highly educated, the majority (80%) of parents of studied cases lacked consanguinity degree, while only 20% from them had consanguinity from first degree; the vast majorities (92.5%) of the cases were not presented with family history of autism. As regards comorbidity, 90% of the cases were associated with one or more comorbid conditions and the presence of more than one comorbidity usually associated with male sex and severe type of autism, 72.5% of studied cases suffered from comorbid tics (40% occurs in severe autism), 25% of cases presented with associated attention-deficit/hyperactivity disorder, 20% of cases suffered from oppositional defiant disorder (ODD) as comorbid conditions, 37.5% of studied cases had comorbid obsessive compulsive disorder (OCD), and 5% of cases suffered from comorbid general anxiety disorder. Conclusion From the current study it was concluded that boys, high and moderate socioeconomic states, consanguinity, positive family history represented conditions that are associated with an increased risk for autism and ASDs in Egyptian population. Presence of one or more of those risk factors in children with autism is usually associated with severe type of the disease and more associated comorbidities. Determining the contribution of these risk factors may improve detection, earlier treatment, and better prevention of the disease. Comorbid tics, attention-deficit/hyperactivity disorder, ODD, and OCD are most presented among boys, whereas comorbid general anxiety disorder is more presented in girls with autism. The most occurring coincidence of comorbidity is comorbid tics and OCD, followed by comorbid OCD and ODD. Those coincidences were associated with severe autism and male sex. We suggest future studies using large samples to confirm the finding of the present work.